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.
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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. |
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Preauthorization Requirements Lists
View the current list of services/procedures requiring preauthorization based on the relevant member coverage type:
- Select Health Commercial Plans (Utah and Idaho)
- Select Health Commercial Plans (Nevada)
- Select Health Medicare™
- Select Health Community Care® (Medicaid/CHIP)
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.