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 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 forms

We want your feedback

We want to learn more about your experiences with ICM and our preauthorization process. When calling our office, please remain on the phone after speaking with our preauthorization team and you will have the opportunity to take a brief survey and let us know how we did. Your valuable feedback will help us improve our services.