Umpqua Health 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.

• To access the provider portal, click this link: https://cim1.phtech.com/cim/login.
• Follow these instructions if you need help on how to sign up for CIM access.
• Step-by-step instructions for how to submit a PA are located in our Utilization Management & Service Authorization Handbook.

Medical, Behavioral health & DME Authorizations

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

We 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.