Members Handbook – Machine Readable
This is the machine-readable version of the 2026 Member Handbook.
Medical, Behavioral and SUD Prior Authorization Form
Prior authorization request form for providers submitting medical, behavioral health, and substance use disorder service requests for Umpqua Health Alliance members.
Medication Management Referral Form
Referral form for submitting patients to Umpqua Health Alliance’s Medication Management Program, completed by the referring provider and submitted to UHA Pharmacy Services by fax or email.
Pharmacy Prior Authorization Criteria
Pharmacy Prior Authorization Criteria outlines requirements and clinical criteria for medications requiring prior authorization, supporting consistent review and approval decisions for covered pharmacy services.
Professionally Administered Drug (PAD) Prior Authorization Form
Prior authorization request form for professionally administered drugs (PAD), requiring supporting clinical documentation submitted to Umpqua Health Alliance’s pharmacy team by fax or phone.
Pharmacy Prior Authorization Grid
Umpqua Health Alliance’s pharmacy prior authorization grid listing prescription drug categories that require prior authorization, with fax and phone contact information and documentation requirements.
NOABD FAQs (Spanish)
Encuentre respuestas a preguntas frecuentes sobre determinaciones adversas de beneficios.
NOABD FAQs
Find answers to frequently asked questions about adverse benefit determinations.
UHA Complaint Form (Spanish)
Utilice este formulario para enviar una queja por escrito a Umpqua Health.
UHA Complaint Form
Use this form to submit a written complaint to Umpqua Health.
HRSN Nutrition Service Request Form
Fully fillable Nutrition Request Form for members and providers requesting Health-Related Social Needs (HRSN) nutrition services and related benefits.
HRSN Housing Service Request Form
Use this form to request housing assistance services.