Preauthorization Forms and Lists
Preauthorization Request Forms
Preauthorization forms must be submitted when not using CareAffiliate or PromptPA.
Access the relevant request form for your practice using the table below.
Utah & Idaho All Commercial Plans, Select Health Medicare Select Health Community Care® (Medicaid) in Utah only |
Nevada Select Health Med® Network Select Health Medicare |
Colorado Select Health Value Select Health Medicare Advantage |
Request for Medical Preauthorization
Behavioral Health-Related Preauthorization--Initial Request Learn more about services/procedures requiring preauthorization. Use PromptPA for prescription and durable medical equipment preauthorization requests. |
Preauthorization Requirements Lists
View the current list of services/procedures requiring preauthorization based on the relevant member coverage type:
- Select Health Commercial Plans (Utah)
- Select Health Commercial Plans (Idaho)
- Select Health Commercial Plans (Nevada)
- Select Health Commercial Plans (Colorado)
- Select Health Medicare
- Select Health Community Care® (Medicaid/CHIP)
Non-Covered Code Lists
Access non-covered codes (or those covered with preauthorization requirements) by state and plan type*:
- Commercial Non-Covered Codes: Utah, Colorado, Idaho, Nevada
- Medicare Non-Covered Codes: Utah, Colorado, Idaho, Nevada
- Medicaid Non-Covered Codes: Utah Only
Download Using Online Covered-Codes Files for tips on quickly searching for the information you need.
* This information is updated quarterly and subject to plan specifics. For questions, contact Member Services at 800-538-5038.