Services requiring preauthorization

How does preauthorization work?

Preauthorization is when your provider sends a request for coverage of a service on the UMP preauthorization list. Some services must be preauthorized before they are performed. After your provider submits this request, the plan will either approve or deny it. The information needed depends on the service for which preauthorization is being requested. To learn more, providers may read plan medical policies or call Provider Services at 1-888-849-3682.

Alert! Requesting preauthorization does not guarantee coverage. Services that aren't approved may not be covered.

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, the plan must receive it within 45 calendar days of the date on the letter requesting the information. 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.

Which medical services require preauthorization?

We do not list these services here because the list changes frequently. Visit the PEB Forms and publications page to find the most up-to-date preauthorization requirements for UMP plans

If you have questions, call UMP Customer Service at 1-888-849-3682.

How are preauthorization and plan notification different?

Notification means that your provider must tell the plan when you receive certain services (listed below). 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
TTY: 711
Business hours: Monday–Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. Pacific Time