Out of Network Appeals
If you are a SelectHealth AdvantageSM
network provider, please visit selecthealthadvantage.org
for appeals information.
For out-of-network providers:
If you wish to file an appeal, please submit a written request to:
Attention: Appeals Dept.
PO Box 30196
Salt Lake City, UT 84130
All provider appeals must be received within 60 days of the Remittance Advice (RA) date in order to be considered. Appeal submissions should include a copy of the original claim(s), a copy of the RA, copies of medical records that would support the appeal, a Waiver of Liability form
(if applicable), and any other documents that would support overturning the denial.
An out-of-network provider may become a party to an appeal only if the provider has executed a waiver of liability statement. This form ensures that the enrollee will not be held financially responsible for any charges should the provider lose the appeal.