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  • The Selecthealth Request For Preauthorization Form - Intermountain ... - Intermountainphysician

Get The Selecthealth Request For Preauthorization Form - Intermountain ... - Intermountainphysician

P.O. Box 30192 Salt Lake City, UT 84130 801-442-5038/800-538-5038 selecthealth.org Request for Medical Preauthorization Today s Date Contact Name / Dates of Service Ph#( / / to Fax#( Date of Birth.

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Intermountain and SCL entered into a merger agreement to combine their health systems in December. The merger was completed in April, creating a $12 billion system and expanding Intermountain's reach into Colorado.

SelectHealth is a subsidiary of Intermountain Healthcare.

SelectHealth is a non-profit health plan serving more than one million members in Utah, Idaho, and Nevada. We are committed to helping our members and everyone in our communities stay healthy. In fact, we share a mission with Intermountain Healthcare: Helping people live the healthiest lives possible.

If you want to submit a claim to SelectHealth, rather than the provider submitting the claim for you, you may fill out a Claim Reimbursement Form. Follow the instructions on page 2. Generally, claims must be submitted within one year from the date of service, though longer time limits do exist in certain circumstances.

UT-based Intermountain Healthcare will now be known as Intermountain Health to emphasize the health system's role in keeping people healthy.

If you are outside of Utah, Idaho, or Nevada and have an emergency or need urgent care, participating benefits apply to services received in a doctor's office, urgent care facility, or emergency room.

What differentiates SelectHealth from many other health plans? As a not-for-profit subsidiary of Intermountain Healthcare®, we are committed to a shared mission of “Helping People Live the Healthiest Lives Possible.” What does that mean for providers?

Intermountain and Colorado-based SCL Health announced that they completed their merger on April 1, 2022. The combined system employs more than 58,000 people and operates 33 hospitals.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232