Through the Community Integration Manager (CIM) portal, providers can submit, check the status of, and manage prior authorization (PA) requests online. By signing up for access to CIM, providers can reduce paperwork and eliminate faxing associated with the authorization process. CIM also provides direct, secure communication with UHA Member Services, Prior Authorization (PA), and Claims teams to assist with questions related to member eligibility, as well as monitoring PA and claims statuses.

• To access the provider portal, click this link: https://cim1.phtech.com/cim/login.
• Follow these instructions if you need help on how to sign up for CIM access.
• Step-by-step instructions for how to submit a PA are located in our Utilization Management & Service Authorization Handbook.

In-network providers must submit PA requests through CIM. See the instructions above for how to sign up. All communications and notifications will be sent securely within CIM.

Out-of-network providers are encouraged to submit requests through the CIM portal. However, they may also submit via fax using the Medical, Behavioral, and SUD Prior Authorization Form.

If fax is temporarily unavailable, requests may be submitted by email.

All submissions—whether through CIM or fax—must include medical notes, prescriptions, and supporting documentation. Documentation must be current and dated within six months of the submission.

Check out our Medical, Behavioral and SUD Prior Authorization Form for clarification on our prior authorization (PA) turnaround times, criteria and other requirements and helpful information. Additionally, the Behavioral Health Prior Authorization Provider FAQ can help with frequently asked questions on submissions for mental health and substance use disorder (SUD) services.

Special Financial Arrangements (SFA) and Single Case Agreements (SCA) must be requested on the PA. If an SCA is not requested, the PA will be processed at DMAP rates. In-network providers claims will be paid at their contracted rate unless otherwise indicated. Items without a DMAP rate (manual) must be sent with a requested/billed rate or the request may be denied until the information can be provided.

An approved authorization is not a guarantee of payment. Payment is based on benefits in effect at the time of service, member eligibility and medical necessity/appropriateness.

We may not authorize services under the following circumstances:

• The request received by UHA was not complete;
• The provider did not hold the appropriate license, certificate, or credential at the time services were requested;
• The recipient was not eligible for Medicaid at the time services were requested;
• The provider cannot produce appropriate documentation to support medical appropriateness, or the appropriate documentation was not submitted to UHA;
• The services requested are not in compliance with OAR 410-120-1260 through 410-120-1860.

Retro Requests-Must include dates for services already provided. Supporting documentation for each date of service is required. Any requests for authorization more than  30 days from the date of service (90 days for Behavioral Health services) requires documentation from the provider that indicates why authorization could not be obtained within the required timeframe from the date of service.