What is the procedure for prior authorization?

The procedure for obtaining prior authorization with UMR typically involves several key steps that ensure medical services or medications are authorized before they are provided. First, the healthcare provider submits a request for prior authorization to UMR, detailing the medical necessity of the treatment or service. This request may include information such as the patient's medical history, the specific procedure or medication being requested, and any relevant clinical guidelines. Once the request is submitted, UMR reviews the information to determine whether it meets their criteria for medical necessity and appropriateness based on the plan's coverage guidelines. The review process may involve consultations with medical professionals or specialists to assess the necessity of the treatment. After the review is completed, UMR communicates its decision to the healthcare provider. If authorization is granted, the provider can proceed with the treatment or service. If the request is denied, UMR provides the reasons for the denial, allowing the healthcare provider and patient to understand the decision. It is important for patients to stay informed about their specific plan details as procedures and requirements may vary. For more specific information, it may be helpful to check the current web page for detailed instructions or contact information.