Umpqua Health Alliance has recently launched our newest prior authorization processing enhancement. Click here for more details.

As of January 1, 2020 UHA is no longer reviewing prior authorizations for ATRIO health plans. Please send all PA requests for ATRIO primary members to P3 at their Douglas County fax number, (541) 672-4318. If you have any questions, you can reach the P3 prior authorization department at (503) 391-4922 or via email at umanagement@p3hp.org.

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, and Claims teams that can assist you with questions of member eligibility, and monitoring PA and claims status’. UHA is encouraging all in network providers to gain access to CIM as soon as possible as it will be a requirement in the first quarter of 2020.

Use the following tools for medical prior authorization guidelines and requirements:

• Prior Authorization Grid – Overview
  • DME Prior Authorization Grid
  • DME Vendor Grid
• Medical, Behavioral and SUD Prior Authorization Form
• Psychological Evaluation Form
• Utilization Management & Service Authorization Handbook
• Behavioral Health Prior Authorization Provider FAQ

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

• Pharmacy Services

For more information regarding UHA’s Case Management and Behavioral Health programs, please visit our Behavioral Health page. To submit a referral for patient services, use the forms below:

• Case Manager Referral Form
• Hepatitis C Case Management Referral Form
• Health Related Services Form
• Coordination of Benefits Intake Form

As a Coordinated Care Organization (CCO), Umpqua Health Alliance (UHA) shall provide medically appropriate, cost effective health services including substance use disorder treatment, skilled nursing facility services and flexible services within the scope of the member’s benefit package of health services in accordance with the Prioritized List of Health Services and the terms of the Coordinated Care Organization (CCO) Contract and Oregon Administrative Rules (OAR) 410-141-3820 and 410-141-3835. To access some of these resources, please use the links below:

• Clinical Practice Guidelines
• HERC Guidelines
• Prioritized List
• DMAP Fee Schedule
• Oregon Health Plan for Providers
• Informed Consent Form – Hysterectomy Consent
• Informed Consent Form – Hysterectomy Consent (Spanish)
• Informed Consent Form – Consent to Sterilization for Members 21+
• Informed Consent Form – Consent to Sterilization for Members 21+ (Spanish)
• Informed Consent Form – Consent to Sterilization for Members 15 – 20
• Informed Consent Form – Consent to Sterilization for Members 15 – 20 (Spanish)

Visit our Provider Resources page for more information, including the Provider Handbook and direct provider communications in our Provider Newsletter.