Uniform Medical Plan (UMP)

Uniform Medical Plan (UMP) is a health plan offered through the Washington State Health Care Authority’s (HCA) Public Employees Benefits Board (PEBB) and the School Employees Benefits Board (SEBB). UMP is administered by Regence BlueShield and Washington State Rx Services.

Uniform Medical Plan

Medical management programs

The following medical management programs apply to UMP members. Note: HTCC decisions will be incorporated, as appropriate.

Sleep Medicine: Services subject to the program's pre-authorization requirements

Physical Medicine:

  • Most services are subject to the program's pre-authorization requirements
  • Spinal injections may be subject to HTCC decision and will require a provider attestation form. Submit the form through Availity Essentials to avoid claims processing delays.
  • Neurodevelopmental, occupational, physical and speech therapy (NDT/OT/PT/ST) visits are subject to the program's pre-authorization requirement. Pre-authorization is required for more than 18 visits per injury or episode of care for neurodevelopmental, occupational, physical or speech therapies.

Radiology: Services subject to the Advanced Imaging Authorization program's pre-authorization requirements

Learn more about these programs.

On-demand health care at home

DispatchHealth is a health care delivery service designed to reduce emergency room visits for non-emergencies and ensure patients with acute health care needs receive care in a timely manner. DispatchHealth serves as a mobile urgent care service that provides care in the home setting when your team is unavailable or when your patients are unable to transport themselves to your office for care.

Regence UMP members have access to DispatchHealth in Idaho (Boise area), Oregon (Portland area) and Washington (Seattle, Spokane, Tacoma and Olympia areas). View DispatchHealth’s service area and verify access using a ZIP code. Note: The program may not apply to all UMP Plus plans.

How it works for members

DispatchHealth is available seven days a week, 365 days a year. View a list of hours and locations. Members can request care through the DispatchHealth website or call the toll-free number: 1 (888) 908-0553.

Medical providers will review the member’s symptoms to understand their needs and ensure DispatchHealth can provide the necessary care. When appropriate, DispatchHealth will recommend the member to the emergency room. Note: A board-certified emergency room physician is always available virtually.

After requesting care, they will then provide the patient with an estimated time of arrival, and a team of trained emergency medical professionals (a physician assistant or nurse practitioner with a medical technician) will arrive at the member’s location. The DispatchHealth team arrives with all the equipment needed to treat injuries and illnesses such as: chronic obstructive pulmonary disease and exacerbations; severe cold and flu symptoms; urinary tract infection; broken bones, sprains and bruises; lacerations, abrasions and infections; mild to moderate stomach pains, nausea, vomiting and dehydration. The medical team can also run onsite labs, initiative IVs, order x-rays and issue prescriptions. View a complete list of the conditions and symptoms they treat.

The onsite team will fully document your patient’s visit and fax clinical documentation back to you 24 to 48 hours after the visit. When immediate follow-up is needed, you will receive a call from DispatchHealth. Additionally, DispatchHealth follows up with every patient within three days and refers the patient back to you for additional care, as needed. DispatchHealth submits claims directly to the patient’s health plan for the care provided.

Refer a patient to care

DispatchHealth can be an extension of your team and will ensure that your patients return to your supervision quickly and conveniently.

You can refer a patient to care by calling the Regence-specific phone number for any of the locations below at 1 (425) 651-2473 in Washington and 1 (503) 917-4904 in Oregon:

  • Portland, OR
  • Seattle, WA
  • Tacoma, WA
  • Olympia, WA
  • Spokane, WA

When calling DispatchHealth, you will be asked to give some patient details, including the patient’s phone number and condition or symptom. (Note: If you are on the phone with the patient, you can warm transfer them to DispatchHealth.) Once DispatchHealth connects with the patient, DispatchHealth will obtain verbal consent for the visit and finish the onboarding process. They will then provide the patient with an estimated time of arrival and will send out their clinical team.

Care management programs

UMP offers several programs to help members improve their health, including knee and hip replacement, spine care, diabetes prevention and management, tobacco cessation, maternity support and expert second opinions.

Learn about these programs for PEBB and SEBB members.

Mental health services from Quartet, a mental health technology company, will be available at no charge to UMP members ages 18 and older who reside and are seeking care in Washington state. Quartet facilitates access and promotes an integrated approach to care by connecting members, primary care physicians and behavioral health providers to their web-based care coordination platform. Quartet’s SmartMatch algorithm and Care Navigation team match members to in-person and telemedicine outpatient mental health providers who are in-network, have availability and offer an array of mental health services, including but not limited to: therapy, psychiatric care, outpatient substance use disorder services and severe mental illness treatment.

Learn more at quartethealth.com.

Diabetes Prevention Program
UMP members ages 18 and older and not a Medicare member with risk factors for prediabetes may have access to Omada, an online program.

The program combines proven science with personalized support to help participants build healthy habits that last—whether that means improving eating habits, activity levels, sleep or stress management. The program includes:

  • A professional health coach for one-on-one guidance to help keep participants on track.
  • A wireless scale to monitor progress. Participants will receive a ready-to-use device in the mail, already synced to their private account.
  • Weekly online lessons to educate and inspire. Participants are guided through online lessons that tackle physical, social and psychological components of healthy living. Interactive games reinforce learning and help participants make connections to real-world scenarios.
  • A small peer group for real-time support. Participants are matched with like-minded participants for added encouragement and accountability.

Members will complete an online screening to determine eligibility based on their BMI and risk factors of prediabetes. The program is offered at no cost to eligible members.

More information about the program is available on Omada's website.

Diabetes Management Program (for SEBB members only):

UMP SEBB members ages 18 or older with Type 1 or Type 2 Diabetes have access to the Omada virtual diabetes management program through their smartphone app, tablet, or computer.

The program is based on the clinically proven Diabetes Self-Management and Education program. Care teams develop personalized care plans with each member based upon individual goals and taking clinical needs into account.

The program includes:

  • A professional health coach for one-on-one guidance to help keep participants on track.
  • A dedicated Certified Diabetes Care and Education Specialist.
  • A wireless cellular connected scale and blood glucose monitor to track progress (strips and lancets included). Participants will receive the ready-to-use devices in the mail after registering and being accepted into the program, already synced to their private account.
  • Personalized feedback and cognitive behavioral therapy tools to assist members with foundational lifestyle changes as well as drive engagement.
  • A small peer group for real-time support. Participants are matched with participants who share the same or similar interests as them for added encouragement and accountability.
  • Food and activity tracking tools.

Members will complete an online screening to determine eligibility based on a diagnosis of diabetes and other health related conditions. The program is offered at no cost to eligible members.

Note: Certain connected devices and features provided as a part of an Omada program are only available to members in the applicable program who meet program and clinical eligibility requirements.

More information about the program is available on Omada's website.

Healthwise decision-making tools
We are pleased to join other top health plans, health systems and hospitals, care management companies, and consumer health portals by making Healthwise’s Knowledgebase available to all Regence providers, as well as to UMP members. The knowledgebase includes:

  • Evidence-based, easy-to-understand health education
  • Innovative technology solutions that integrate with complex health IT systems
  • Expert guidance on game-changing approaches, such as behavior change and shared decision-making

Healthwise provides content and technology to help people make better care decisions and manage their health, including information about health topics, videos and tools on hundreds of specific conditions, prevention, life stages and more. We encourage you to use and share this source of information with your patients so they can learn about their health condition(s).

Healthwise has been in business for 40 years and has the following achievements:

  • URAC Certificate of Full Accreditation, 2022-2025
  • NCQA Certification, 2022-2024—Healthwise Self-Management Tools

Learn more.

Virtual behavioral health support
myStrength is a self-guided health and resiliency online tool clinically proven to improve emotional health. This secure resource is available 24 hours a day, 7 days a week to members ages 13 and over at no cost to members. myStrength’s interactive and activity-based tools are personalized to members and address conditions such as depression, anxiety, stress, substance use disorders, and chronic pain. Visit the myStrength website to learn more.

Other programs and initiatives

If you’re not already, we encourage you to learn about and participate in the following community initiatives:

  • Washington Health Alliance
    The Washington Health Alliance (WHA) is a health system improvement nonprofit organization in Washington. Located in Seattle, the WHA brings together health care stakeholders to create a high-quality, affordable system for the people of Washington state. The WHA also produces and shares the most reliable data on Health Care Quality and value in the state to help providers, patients, employers and union trusts make better decisions about health care.
  • Bree Collaborative
    The Bree Collaborative is a multi-stakeholder, Governor-appointed group working to improve the quality, health outcomes and cost effectiveness of care in Washington. The Bree Collaborative produces best practice recommendations for health care services that experience a high variation of care delivery, are frequently used but do not lead to better care or patient health, or that experience patient safety issues
  • Accountable Communities of Health
    Accountable Communities of Health (ACHs)) are regional health collaboratives that bring together leaders from multiple health sectors with a common interest in improving health and health equity throughout the state. As ACHs align resources and activities that improve whole person health and wellness. Nine ACHs serve the entirety of Washington State, the boundaries of which align with Medicaid Regional Service Areas.

We support the goals of the ACH and the relationship of the Medicaid transformation work with the health care delivery systems in our commercial provider networks.

  • Hutchinson Institute for Cancer Outcomes Research
    Hutchinson Institute for Cancer Outcomes Research (HICOR) is a research institute at Fred Hutchinson Cancer Research Center whose mission is to improve cancer prevention, detection and treatment in ways that will reduce the economic and human burden of cancer. HICOR brings together patient organizations, clinicians, industry leaders, insurers and policy developers to share cancer-related data and generate performance metrics that are clinically relevant and can guide improvements in cancer care.
  • National Business on Health e-Value8 Initiative
    e-Value8 is a transformational resource that helps purchasers and employers measure and evaluate health plan performance. The Washington Health Alliance sponsors a biannual e-Value8 which is supported by the HCA.

We encourage you to use Certified Health Information Technology and participate in Washington State’s Clinical Data Repository and Health Information Exchange.