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Preauthorization

 

SelectHealth requires the attached Request for Preauthorization (RPA) form for all preauthorization requests for all SelectHealth members. This includes Commercial products, SelectHealth Advantage and SelectHealth Community Care. This form will assist you as we move toward the  implementation of our electronic authorization system, Care Affiliate, coming in the latter part of this year. The Request for Preauthorization form has all the same elements that will be required to complete online authorization using Care Affiliate.


*Please submit the RPA form with every request.

*Submit your preauthorization requests with all relevant clinical information.

*Any preauthorization requested without the RPA form will be denied.

*If denied due to lack of a completed RPA form, requests may be resubmitted with a completed RPA form.




Preauthorization for medical procedures is required for all the following: inpatient services; maternity stays longer than two days for a normal delivery or longer than four days for a cesarean; durable medical equipment; home health nursing services; and pain management/pain clinic services.

View Medical Procedures Requiring Preauthorization​


If you have additional questions, call Member Services at 801-442-5038 (Salt Lake area) or 800-538-5038. 

It is the responsibility of SelectHealth to determine whether healthcare services are a covered benefit. Examples of services that are non-covered benefits are procedures, equipment, and/or medications that are cosmetic, investigational, or experimental in nature. SelectHealth may use medical criteria sets and/or physician review to determine whether a procedure is cosmetic, investigational, experimental, or an otherwise non-covered benefit. If a provider’s office has questions about a covered benefit, they are encouraged to use the preauthorization process, whether or not the procedure is on the preauthorization list. Using the preauthorization process to verify benefit coverage can be an important tool in understanding reimbursement.

 

Definition

Preauthorization is a member responsibility if the member is using a non-panel facility. Failure to preauthorize a service may results in standard benefits being reduced up to 50 percent of eligible charges, and member payments are not applied to the member’s out-of-pocket maximum.

Members on a plan with a point of service feature (Select Choice, Select Med Plus and Select Care Plus) are responsible to complete preauthorization for certain services from non-participating providers.


Timeframe

To ensure adequate time for a preauthorization, whenever reasonably possible, notify SelectHealth at least fourteen days in advance of services. 



 

 

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