Services requiring preauthorization

Medical services requiring preauthorization in 2017

Your provider must request preauthorization for some services before they are performed. 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 or would like more information about preauthorization, call UMP Customer Service at 1-888-849-3682.

Services not approved may not be covered by the plan. Requesting preauthorization does not guarantee coverage.

How preauthorization works

Your provider must submit a preauthorization request. The information needed depends on the service for which preauthorization is being requested. For more information, 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.

When more information is needed

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.

If services are denied

You have appeal rights in case of a denial.

Preauthorization and plan notification

Some services require both preauthorization and plan notification. Notification means that your provider must tell the plan if you are admitted to a facility for services requiring notification (listed below). 

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:

Contact

UMP customer service
Phone: 1-888-849-3681
Business hours: Monday–Friday 7 a.m. to 5 p.m. Pacific Time
TTY: 711