Umpqua Health Member

Documents & Forms

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Medical, Behavioral and SUD Prior Authorization Form

Medication Management Referral Form

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.

Medication Prior Authorization Form

Professionally Administered Drug (PAD) Prior Authorization Form

Pharmacy Prior Authorization Grid

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.

Appeals & Hearing Request (Spanish)

Utilice este formulario para enviar una solicitud de audiencia a la Autoridad de Salud de Oregón (OHA).

Appeals & Hearing Request

Use this form to submit a hearing request to the Oregon Health Authority (OHA).

UHA Complaint Form (Spanish)

Utilice este formulario para enviar una queja por escrito a Umpqua Health.