At Innovative Care Management, it is always our goal to provide the most convenient, simple and helpful resources to the people we work with everyday. As an alternative to calling in a preauthorization request, you may use these forms to request a preauthorization at your convenience.
How this process works:
Submitting a Preauthorization Request is a simple alternative to calling our office. Simply complete one of the forms below (select the appropriate one depending on the requested service) and submit the completed form along with pertinent/requested clinical information to ICM for review. You may submit either via fax to 503-654-8570 or via secure email to email@example.com. Please note that standard email is not secure and as such, confidential information should not be transmitted by standard email. Many organizations have access to secure email systems; if your organization doesn’t, please submit requests via fax.
ICM staff will process requests as they are submitted. You may expect a response in 7-10 days for non-urgent requests.
Thank you for taking the time to visit this site, and you can look forward to a prompt reply from one of our Preauthorization Specialists.Standard Preauthorization Form Back Injection Preauthorization Form Bariatric Surgery Preauthorization Form
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