ALERT! The UMP preauthorization list is updated throughout the year. The fact that a service does not require preauthorization or notice does not guarantee coverage. Notice for facility admissions Your provider must notify the plan upon your admission to a facility for services requiring plan notice. You may find a list of services requiring plan notice by visiting the UMP Policies that affect your care webpage or contacting UMP Customer Service (see Directory for link and contact information). Facility admissions for which the plan is not notified may not be covered. Notice is usually done by the facility at the time you are admitted. Notice is not the same as preauthorization and many services require both. What is the difference between preauthorization and notice? ALERT! Many services, including, but not limited to, inpatient services, require both preauthorization and notice. Contact UMP Customer Service or talk to your provider if you have questions about services needing preauthorization or notice. “Preauthorization” is when your provider sends a request for coverage of a service on the UMP preauthorization list. Preauthorization is usually requested by the provider performing the services. The plan sends either an approval or denial of coverage. If the plan does not approve services that require preauthorization before services are received, the plan may deny coverage. The plan does not approve or deny preauthorization for services that are not on the UMP preauthorization list. “Notice” means that your provider must contact the plan to let us know when you receive services. Notice is usually done by the facility when you are admitted. ALERT! If the plan denies preauthorization and you receive those services anyway, you are responsible for the provider’s entire billed charge. How long the plan has to make a decision The plan will respond to standard preauthorization requests submitted by contracted providers within 5 days of receipt for non-electronic requests and within 3 days of receipt for electronic requests. For expedited preauthorization requests, the plan will respond within 1 to 2 days of receipt. If additional information is required, the plan will notify the provider within the timelines described in this section. You will also be notified of the decision. If your provider believes that waiting for a decision under the standard preauthorization timeframe could place your life, health, or ability to regain maximum function in serious danger, they can request an expedited preauthorization request. 110 2024 UMP Classic (PEBB) Certificate of Coverage