Select Health Policies

Policy Development

Select Health medical, dental, and coding/reimbursement policies represent our determination of whether services or devices are standard medical practice, experimental/investigational, cosmetic, or within coding standards. NOTE: By accessing and/or downloading Select Health policies, you automatically agree to the Medical and Coding/Reimbursement Policy Manual Terms and Conditions.

Pharmacy Policies

• View member pharmacy policies state by state and by drug here. 
• Use PromptPA to obtain preauthorization for prescriptions and infusible drugs and to see pharmacy coverage requirements.
• To submit a pharmacy-related appeal, please follow this simple process:
  • Step 1: Access the online appeals form.
  • Step 2: On the appeals form, be sure to select plan, fill in required fields, and attach supporting documentation (if necessary).
  • Step 3: Click the submit button at the bottom right of the form. 

Policy Resource

• FDA Overview of Device Regulation

InterQual

Select Health uses InterQual coverage criteria when medical policy is not available. This information can be obtained by signing into the One Healthcare ID portal.