Preauthorization Request | Client Portal
Preauthorization Request
Client Portal

ICM Preauthorization Request

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:

  1. Select and complete the appropriate form depending on the services needed.
  2. Submit your completed form along with pertinent/requested clinical information to ICM for review using one of the following methods:
    • Upload documents to our secure website (click to upload files)
    • FAX to 503-654-8570
    • Send via secure email to onlineprecert@innovativecare.com. (Please only choose this option if you have access to a secure email system. Standard email platforms are not secure enough to securely send confidential information.)

The statements below are required by specific states, but are applicable in general to all states:

ICM applies MCG guidelines (www.mcg.com) as the primary clinical review criteria for services, including but not limited to ambulatory, general medical and surgical, inpatient acute and sub-acute, hospice/end-of-life, and behavioral health care which includes substance use disorders. MCG is an industry-leading set of proprietary evidence-based care guidelines and provides length of stay guidelines for services across the continuum of care.

For specific preauthorization requirements, please consult the plan’s Third Party Administrator.

PREAUTHORIZATION FORMS

How this process works:

  1. Select and complete the appropriate form depending on the services needed.
  2. Submit your completed form along with pertinent/requested clinical information to ICM for review using one of the following methods:
    • Upload documents to our secure website (click to upload files)
    • FAX to 503-654-8570
    • Send via secure email to onlineprecert@innovativecare.com. (Please only choose this option if you have access to a secure email system. Standard email platforms are not secure enough to securely send confidential information.)

The statements below are required by specific states, but are applicable in general to all states:

ICM applies MCG guidelines (www.mcg.com) as the primary clinical review criteria for services, including but not limited to ambulatory, general medical and surgical, inpatient acute and sub-acute, hospice/end-of-life, and behavioral health care which includes substance use disorders. MCG is an industry-leading set of proprietary evidence-based care guidelines and provides length of stay guidelines for services across the continuum of care.

For specific preauthorization requirements, please consult the plan’s Third Party Administrator.

PRE-AUTHORIZATION FORMS