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Claim Forms and FAQs

Select Health's Provider Benefit Tool (PBT) is the online resource for managing all aspects of provider claims.

Claim Forms

Frequently Asked Questions

Verify member eligibility by checking member ID cards or by logging into the Provider Benefit Tool (Need to enroll? See steps below.)

Submit the claim via:

  • Electronic Data Interchange (EDI) transaction
  • U.S. Mail to:
    • P.O. Box 30192 SLC, UT 84130 (for Commercial/Medicaid/CHIP)
    • P.O. Box 30196 SLC, UT 84130 (for Medicare claims ONLY)
  • Payer ID 20501, P.O. Box 211375, Eagen, MN 55121 (for Medicare claims in NV only)

Monitor submitted claim with Provider Benefit Tool.

Monitor NV Medicare claims here. 

Once a claim has been paid, providers receive either an electronic remittance advice as an Electronic Data Interchange (EDI) transaction or as a paper remittance advice. Access a Sample Remittance Advice and a Remittance Advice Key for more information.

(for contracted providers and facilities not currently enrolled)

  1. Request access by submitting an application and agreement.
  2. Submit completed app and agreement via email.
  3. Monitor email for confirmation (approx 30 to 45 days).
  4. Log in to PBT.

New user enrollment

(for contracted providers and facilities already enrolled)

  1. Email an application for each new user.
  2. Monitor email for confirmation (approx 30 days).
  3. Log in to PBT.

Save time tracking eligibility and claims status using search options for patients, claims, or remittance advice.

Download and complete forms using Google Chrome.

Download our Cybersecurity Guide for full details.

Use of the PBT requires access to the Select Health secure Provider Access Point. To protect the security of our providers, clinic staff with access can only view provider data for those practicing under designated Tax ID number(s) on file.