How this process works:
Submitting a Preauthorization Request is a simple alternative to calling our office. Complete one of the forms (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 by uploading documents to our secure website (click to upload files), via fax to 503-654-8570, or by secure email to onlineprecert@innovativecare.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 the upload option or by fax.
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.
Upon receipt of a request for preauthorization, concurrent, or retrospective review, ICM will request the necessary clinical information required to complete the review. Once the requested information is received, we will make a determination as soon as possible, and within Department of Labor (DOL) timeframes. If we do not receive all the requested information within the specified timeframe, we will issue a determination with the information we have received.
If a request is denied due to a lack of information, the provider may submit the necessary additional clinical information to ICM for reconsideration.
If the provider is unwilling to release necessary information, certification may be denied.
Prior Auth for DME (Arizona Providers Only)
Prior Auth Request Form for Health Care Services (Arizona Providers Only)