Services requiring preauthorization

How does preauthorization work?

Preauthorization is when your provider sends a request for UMP to cover a service on the UMP preauthorization list. The preauthorization process makes sure certain services are medically necessary for you. 

After your provider submits this request, the plan will either approve or deny it. The information needed for a request depends on the service being requested. To learn more, providers may read plan medical policies or call Provider Services at 1-888-849-3682.

The plan will notify your provider that:

  • The services have been approved and will be covered;
  • The services have been denied and will not be covered; or
  • More information is needed to make a decision.

You will be notified in writing of one of these three outcomes within 15 days of when the plan received the preauthorization request.

You have appeal rights in case of a denial. If more information is needed, you have up to 45 calendar days after the date on the notification letter to submit it. After the plan receives the extra information, you will be notified within 15 days whether the services will be covered. If the plan does not receive the requested information within 45 days, the case will be reviewed without it. You will be notified of the decision within 15 days after the date by which the extra information should have been received.

Alert! Requesting preauthorization does not guarantee coverage. Services that aren't approved may not be covered. Excluded, experimental, and investigational services do not require preauthorization because UMP does not cover them.

Which medical services require preauthorization?

We do not list these services here because the list changes frequently. Find the most up-to-date list of services requiring preauthorization on the Regence website. You can also get this information in PDFs that are easier to download.

If you have questions, call UMP Customer Service at 1-888-849-3681.

Looking for drugs that require preauthorization? Call Washington State Rx Services at 1-888-361-1611 or check the UMP Preferred Drug List (select your plan before you search). You and your prescribing provider can also find the coverage criteria for your drug.

How are preauthorization and plan notification different?

Preauthorization means your provider must request that UMP cover a service on the UMP preauthorization list. Notification means that your provider must tell the plan when you receive certain services (listed below). Your provider submits a preauthorization request; notification is usually done by the facility at the time you receive services. Some services require both preauthorization and plan notification.

Facility admissions for which the plan is not notified may not be covered.

Note to providers: If you are contracted with Regence, log in to your Regence provider account for more about notification and preauthorization. Non-contracted providers, call Regence Provider Services at 1-888-849-3682.

The following services require plan notification:

  • All inpatient hospital and facility admissions.

  • Chemical dependency treatment:
    • Detoxification.
    • Inpatient services, including to a residential treatment facility.
    • Intensive Outpatient Program (IOP).
    • Partial Hospitalization Program (PHP).
  • Mental health services:
    • Inpatient services, including to a residential treatment facility.
    • Partial Hospitalization Program (PHP).

Contact

UMP Customer Service
Phone: 1-888-849-3681
TRS: 711
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time