PRIOR AUTHORIZATIONS

Access

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.

Medical & DME Authorizations

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

Pharmacy Authorization

Use the following tools for pharmacy-related prior authorization guidelines and requirements:

Case Management & Behavioral Health Referrals

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:

Medicare Members

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.

Additional Resources

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:

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

Contact Us

For all prior authorization questions, please contact us at PriorAuthorizations@umpquahealth.com

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