Select Health Prior Authorization

Select Health prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Select Health requires preauthorization requests to be submitted through its online preauthorization tools when available. The Commercial and Government provider manual says requests should be submitted via CareAffiliate or PromptPA, with downloadable forms available if the online tools are not used. For online medical preauthorizations created on or after September 15, 2025, Select Health directed providers to the new Preauth & Care Plan Tool; PromptPA, email, and fax were not changed by that launch notice. For Select Health Community Care (Medicaid), the manual states the Request for Preauthorization (RPA) form is required, with fax, phone, mail, and email/scan intake options listed for that line of business.
• The provider manual says notifying Select Health alone does not complete preauthorization.
• For services from a non-panel facility, the manual says preauthorization is a member responsibility.
• The manual says failure to preauthorize can reduce benefits up to 50 percent of eligible charges for certain plans/services.
• The September 15, 2025 tool-change notice says online medical preauthorization requests created on or after that date should use the Preauth & Care Plan Tool, but it does not apply to PromptPA, email, or fax submissions.
• Requirements can vary by plan type and individual contract.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Preauth & Care Plan Tool (medical preauthorization; online)

• CareAffiliate (legacy online tool; per transition notice)

• PromptPA (pharmacy/medication preauthorization)

• Select Health Request for Preauthorization form / downloadable forms

• Fax (line-of-business specific)

• Email / scan (line-of-business specific)

• Mail (line-of-business specific)

• Phone discussion for peer-to-peer / utilization management questions

• Submission resource 1

• Submission resource 2

• Submission resource 3

Information commonly required

• Subscriber number
• Provider of service
• Facility
• Diagnosis code(s)
• Date of service
• Place of service
• Procedure code(s)
• Medical necessity documentation for requested services
• Medical coding details (e.g., ICD-9/10, CPT) for Medicaid intake

Turnaround notes and caveats

• Commercial/Government manual: urgent requests are processed within 72 hours of receipt; standard medical requests within 14 calendar days, with a possible 14-day extension if additional information is needed.
• Select Health Community Care manual: medically urgent requests are processed within 72 hours; standard medical requests within 14 calendar days, with possible 14-day extension.
• Provider appeal and medical preauthorization processes are separate.
• The provider manual says notifying Select Health alone does not complete preauthorization.
• For services from a non-panel facility, the manual says preauthorization is a member responsibility.
• The manual says failure to preauthorize can reduce benefits up to 50 percent of eligible charges for certain plans/services.
• The September 15, 2025 tool-change notice says online medical preauthorization requests created on or after that date should use the Preauth & Care Plan Tool, but it does not apply to PromptPA, email, or fax submissions.
• Requirements can vary by plan type and individual contract.

Provider resources

• Provider Reference Manuals (official)
• Provider Benefit Tool (official)
• Provider Access Point / Join Our Networks (official)
• Preauth & Care Plan Tool announcement (official)
• Claims submission / EDI resources (official)

Sources