About the Preauth and Care Plan Tool

This online preauthorization system is a great time-saver for your practice. As we transition from fax/email preauthorization requests to electronic requests only, switching to the Preauth & Care Plan Tool now will help your practice prepare for the future.

With this tool, your practice benefits from:

• Fewer overall required steps to preauthorization for your patients
• No more duplicative efforts and potential errors when staff enter information from a paper form
• Reduced response time, follow-up calls, and decision delays due to missing information
• No risk of faxed member information being lost or sent to the wrong fax number
• Access to approval/denial letters

Auto-Review Process

To reduce the time needed for preauthorization, we have identified several services for which requests can be automatically evaluated. For these specific services, the Preauth & Care Plan Tool compares the request to established criteria as follows:

• If criteria are met, the preauthorization will be automatically approved with no further review required.
• If criteria are not met, the preauthorization request is automatically sent to medical staff for review.

Preauthorization approved using this auto-review process will be examined to confirm that the clinical documentation submitted with request supports the authorized services.

Each clinic will be reviewed periodically, drawing from random samples of their authorizations. Clinics need to pass this review with a 90% accuracy rate. When providers don’t achieve a passing score, Select Health will:

• Provide personalized coaching on inconsistencies and recommendations to promote accurate documentation
• Conduct a follow-up review to ensure recommendations have been instituted
• Evaluate clinic eligibility for future auto-reviews only after three unsuccessful reviews