Provider Portal Instructions
Medical, Behavioral and SUD Prior Authorization Form
Medication Management Referral Form
Pharmacy Prior Authorization Criteria
Pharmacy Prior Authorization Criteria approved at P&T Committee Meeting
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.