Contact Us

For all prior authorization questions, please contact us at

Submitting a Prior Authorization

Umpqua Health Alliance offers providers the ability to submit, check the status and manage your prior authorization (PA) requests online. By signing up for access to our Community Integration Manager (CIM), you can eliminate paperwork and faxing associated with the authorization process. You will also have direct email access to our Member Services, Prior Authorization (PA), and Claims teams that can assist you with questions of member eligibility, and monitoring PA and claims status’.

UHA requires all in-network providers to submit PA requests through CIM.

Medical, Behavioral health & DME Authorizations

Check out our Medical, Behavioral and SUD Prior Authorization Form for clarification on UHA’s 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.

In-network providers must submit PA requests through CIM. See the Submitting a Prior Authorization section above for how to sign up. All communications and notifications will be sent securely within CIM. Out-of-network requests must be completed on the Medical, Behavioral and SUD Prior Authorization Form. All submissions, via CIM and fax must include medical notes, prescriptions, and supporting documentation with the request. These notes must be current within six months of the submission.

Special Financial Arrangements (SFA) and Single Case Agreements (SCA) must be requested on the PA. In-network providers claims will be paid at their contracted rate unless otherwise indicated. Items without rate (manual) must be sent with a requested/billed rate or may be denied until more 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.

UHA 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.

Any requests for authorization after 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.

Prior Authorization (PA) Grids

Prior Authorization (PA) Grids outline the items and services that require a PA. These documents are searchable by code. Services not reflected on these authorization grid will require an PA.

Prior Authorization – Overview

Pharmacy Authorizations

Visit the Pharmacy Services page for pharmacy-related prior authorization guidelines and requirements.

All members have a right to know about Umpqua Health Alliance’s programs and services.

Members or potential members who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English are called Limited English Proficient or LEP. Anyone who is LEP may be entitled to language assistance for healthcare services/encounters or benefits.

We provide the following at no cost to you:

  • Sign language interpreters
  • Spoken language interpreters for other languages
  • Written materials in other languages
  • Braille
  • Large print
  • Audio
  • Auxiliary Aids and other formats

If you need help or have questions, please call Customer Care at 541-229-4842, Toll-Free 866-672-1551, or TTY 711.

Todos los miembros tienen derecho a conocer los programas y servicios de Umpqua Health Alliance.

Los miembros o miembros potenciales que no hablan inglés como idioma principal y que tienen una capacidad limitada para leer, hablar, escribir o entender inglés se denominan dominio limitado del inglés o LEP. Cualquier persona que sea LEP puede tener derecho a asistencia lingüística para servicios de salud, encuentros o beneficios.

Proporcionamos lo siguiente sin costo alguno para usted:

  • Intérpretes de lenguaje de signos
  • Intérpretes de idiomas hablados para otros idiomas
  • Materiales escritos en otros idiomas
  • Braille
  • Impresión grande
  • Audio
  • Ayudas auxiliares y otros formatos

Si necesita ayuda o tiene preguntas, llame al servicio de atención al cliente al 541-229-4842, al número gratuito 866-672-1551 o al TTY 711.

Start typing and press Enter to search