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Northwest Carpenters Health and Security Plan (group #10057623), is an administrative services only (ASO) group headquartered in Washington. Note: This group was formerly a joint administrative group (group #70000013).
Identifying members
Easily identify members of these groups by the prefix NWC (Active) and ZLL (Medicare retiree) on their member cards. The member cards have a PPO in the suitcase logo. Members have access to the BlueCard PPO Network nationally.
Northwest Carpenters Health and Security Plan sample member card for active members
Eligibility, benefits and claim status
Access member eligibility and benefits and claim information via Availity Essentials, the same as you do today for your other Regence patients.
Pharmacy benefits
Express Scripts administers the pharmacy benefits for retail and mail order prescriptions.
For dates of service on or after January 1, 2024, Northwest Carpenters Health and Security Plan’s coverage of certain medical drugs administered by health care providers will transition from medical benefits to pharmacy benefits.
The provider will need to:
Submit pre-authorization requests to obtain the medical drugs from Express Scripts, the pharmacy benefits manager (PBM) for this group, by calling 1 (844) 581-4862.
- Existing pre-authorizations for patients will not be honored. Providers can begin submitting pre-authorizations to Express Scripts on or after December 1, 2023, for medical drugs received on or after January 1, 2024.
- If a provider submits an electronic authorization through Availity Essentials to Regence, the status will indicate non-covered service with a message: This medication may be covered under the member’s pharmacy benefit. Please contact the PBM for further assistance.
- Submit claims for the medical drugs to Express Scripts.
Submit claims for the administration of the medical drugs to Regence; the administration of the medical drug will continue to be covered under the medical benefits.
- Providers must include a line for the HCPCS code billed to Express Scripts with a penny charge ($0.01) on their claims.
Note: If these medical drugs are administered in the ED or as part of an inpatient hospital stay, the facility should follow the pre-authorization and admission notification requirements on our Commercial Pre-Authorization List and submit claims for the services to Regence.
The Specialty Medications section of our Commercial Pre-Authorization List includes the medical drug HCPCS codes.
Pre-authorization
Our Commercial Pre-authorization List applies to these members except for services authorized by vendors (e.g., AIM or eviCore).
Medical management
Northwest Carpenters Health and Security Plan members have access to our care management program.
Claims and payment
Submit claims electronically for these members the same way you submit claims for your other Regence patients. You will receive payment the same way you do for your other Regence patients.
Customer service
Our Provider Contact Center will supports providers for these members: 1 (877) 276-5906. Members should contact Northwest Carpenters Health and Security Plan Customer Service at 1 (866) 240-9580.
Appeals
Submit provider appeals for these members using the standard provider appeal process for Regence members. You may also submit appeals on behalf of members, following our standard Member Appeals process.