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Preauthorization Guidelines

View Medical Procedures Requiring Preauthorization​


INFORMATION NEEDED FOR PREAUTHORIZATION

The following information is required for preauthorization:

  • Subscriber number
  • Provider of service
  • Facility
  • Diagnosis code(s)
  • Date of service
  • Place of service
  • Procedure code(s)


To ensure enough time for a preauthorization, SelectHealth must receive the request and information at least 14 days before the service or procedure is performed. You may request an expedited review only if the standard 14-day period could result in:

  • Seriously jeopardizing the life or health of the member
  • Seriously threatening the member’s ability to regain maximum function
  • Delaying the care and treatment of this request would subject the member to severe pain and inadequate management of the member’s medical condition

Preauthorization is not a guarantee of payment. Reimbursement of preauthorized services is contingent upon eligibility and benefits at the time of service and services that are covered benefits.

 

Notes: 

Behavioral Health benefits must be coordinated through the member’s EAP representative, if applicable. 

For questions regarding pharmaceutical preauthorization requirements, call the SelectHealth Pharmacy Help Desk at 801-442-4912 (Salt Lake area) or 800-442-3129.

Providers requesting a Peer-to-Peer discussion on a benefit determination may call 801-442-5305.

 

SelectHealth Medical Criteria Sets are outlined in each Medical Policy. Enter your login information then type the applicable policy in the Search field. Criteria are also available upon request by calling 800-442-5305. Please specify if you would like to receive the criteria via mail, fax, or email. Health Services staff are available to discuss Utilization Management (UM) issues from 8:00 a.m. to 5:00 p.m., Monday through Friday. After normal business hours, fax UM questions to 801-442-0517.

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