NOTE: Preauth & Care Plan Tool Unavailable Oct. 9-10
New Update to the Preauth & Care Plan Tool
The Preauth & Care Plan Tool will be getting an update this month, with two key changes that providers should be aware of. Here’s a closer look at what’s changing and what you need to know.
- The My Request and Search Request screens in the Preauth Tool now display the overall Episode Status based on the decisions applied to all lines in the episode. Users can quickly understand the episode's cumulative status without opening individual lines, improving visibility and efficiency in request management.
- My Request status options: Approved, Mixed Decision, Denied and Pending Decision.
- Search Request status options: Approved, Pending Decision, Denied, Mixed Decision.
2. The Requested # field on Add Service screen now defaults to 1 instead of 0, reducing manual input for common service requests. Users can still update the value as needed.
Other Reminders:
Review Select Health Policies Before Submitting Authorization Requests
To help ensure timely processing of authorization requests, providers are encouraged to review the provider policies available within the Preauth and Care Plan Tool.
Policies can be accessed by selecting Menu > Third Party Links > Select Health Policies - Providers.
Reviewing these policies before submitting a request can help providers understand:
- Applicable date span requirements
- Acceptable unit limitations
- Required clinical documentation and supporting records
- Service-specific authorization criteria
Submitting requests that align with Select Health policy requirements helps reduce delays, minimizes requests for additional information, and supports a more efficient authorization review process.
Providers are encouraged to reference these policies prior to submitting requests to ensure all necessary information is included for review.
Reminder for Outpatient Authorizations
When submitting outpatient authorization requests through the Preauth and Care Plan Tool, a facility is required for services performed outside of a physician's office.
Examples include:
- Outpatient Hospital
- Skilled Nursing Facility (SNF)
- Ambulatory/Surgical Center
- Other facility-based outpatient services
Including the correct facility helps ensure accurate processing and reduces delays in authorization review.
Pain Injection Assessment, Changes Effective September 23, 2026
To support recent policy updates, pain injection assessments in the Preauth & Care Plan Tool were updated on September 23, 2026. Providers may notice changes to assessment questions during the authorization submission process. Please refer to the applicable policy for current requirements.