Prior Authorization

Prior Authorization Lookup tool

Providers are responsible for obtaining prior authorization. Providers may not bill members for services that require prior authorization, and the authorization was not obtained, resulting in denial of the claim. Prior authorization requirements are inclusive of secondary claims.

Authorization is not a guarantee of payment. Other limitations or requirements may apply.

How to submit a request for prior authorization

  • Online: NaviNet Provider Portal https://navinet.navimedix.com > Medical Authorizations
  • By phone: 1-888-559-1010 (toll-free) or 1-843-764-1988 in Charleston
  • Fax: Prior Authorization Request Form to 1-866-368-4562

Prior authorization information

Prior authorization forms

Looking for pharmacy prior authorization forms?

Referrals

Participating specialty care health care professionals/providers

Select Health encourages members to seek referral from their primary care provider (PCP) for specialty care when such care is necessary. Prior authorization from Select Health is not required for participating plan specialists for office visits. Some services offered at the participating specialist’s office may require prior authorization.

Participating specialists are advised to contact Medical Services prior to delivering a service if in doubt. For coordination and continuity of care, the specialty care physician is strongly urged to communicate all findings and any needs for follow-up care back to the PCP via a consultation record.

Nonparticipating health care professionals/providers

PCPs and plan participating specialists may refer members to a nonparticipating plan specialist if there is not a participating specialist in a particular field.

However, plan health care professionals/providers who want to refer members to any nonparticipating health care professional/provider must contact Select Health’s Medical Services department for prior authorization.

Providers