Provider Appeals

The SelectHealth Provider Appeals process addresses disputes that arise between a health care provider and SelectHealth. Examples of provider appeals include issues regarding modifiers, multiple surgeries. This process does not apply to appeals dealing with credentialing decisions, contract terminations, member appeals initiated by a provider, or fee schedule issues. If you have questions about any of these issues, contact your SelectHealth Provider Relations Representative.


Filing a formal appeal:

  1. Download the Provider Appeal form​.
  2. Complete the online fillable form and save it to your computer/device (see below).
  3. Mail or fax the form to SelectHealth within 60 days from the date the claim was processed to:

    SelectHealth Provider Appeals
    P.O. Box 30192
    Salt Lake City, UT 84130-0192
    Fax: 801-442-6708

You will receive a written acknowledgement via mail upon receipt of the appeal.

Understanding the review process:

  1. Only submit a provider appeal once to SelectHealth; it will be routed to the appropriate individual/department for a determination.
  2. You will receive a written response within 30 days of receipt of the appeal, indicating the review result.
  3. If you do not agree with the result, contact your Provider Relations representative.


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