---
title: "Select Health ABA coverage in Utah: Medicaid ACO vs. commercial."
url: "https://carelu.com/payers/select-health-utah"
markdown_url: "https://carelu.com/payers/select-health-utah.md"
state: UT (Utah)
payer: Select Health (Utah)
kind: Medicaid managed care plan (MCO)
parent_program: Utah Medicaid
description: "Select Health in Utah is two different products for ABA purposes: SelectHealth Community Care (the Medicaid ACO) rides Utah Medicaid's FFS carve-out, while Select Health commercial plans run their own ABA policy (#630) with a dedicated preauthorization form. What intake needs to ask."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Select Health ABA coverage in Utah: Medicaid ACO vs. commercial.

_Payer Guide · Select Health · Last updated September 2026 · 11 primary sources_

> Two different products under one name: Community Care (Medicaid) rides UT FFS; commercial runs its own Policy #630.

A family saying "we have Select Health" in Utah could mean two structurally different things, and getting it right changes where the ABA request goes. SelectHealth Community Care is one of Utah Medicaid's four ACOs (alongside Health Choice Utah, Healthy U, and Molina) — and Utah Medicaid carves ABA out of every ACO to state fee-for-service, so a Community Care member's ABA request never touches Select Health at all; it goes straight to Utah Medicaid, exactly as our Utah Medicaid guide describes. Select Health also separately sells commercial insurance — employer group and individual/marketplace plans, branded simply "Select Health" — and for those members, Select Health runs its own ABA clinical policy, its own prior-authorization form, and its own utilization-management team. Select Health (the parent brand) is a wholly owned subsidiary of Intermountain Health. This guide covers both paths.

This plan administers the **Utah Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Utah Medicaid guide](https://carelu.com/payers/utah-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — selecthealth.org returns 403 to every automated client; a human must fetch it via carelu.com/sources. Separately, the Utah Medicaid ASD manual (January 2026, read 9/17/2026) does NOT state that ABA is carved out of the ACOs to fee-for-service: it says only that ASD-related medical services go to the MCE and that diagnostic mental-health evaluations/psychological testing are carved out — confirm the ABA carve-out with the Utah Medicaid PA unit (dmhfmedicalpolicy@utah.gov). [9][5]
- **Prior auth for treatment:** Not published / unverified. Verify via: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — selecthealth.org returns 403 to every automated client; a human must fetch it via carelu.com/sources. Separately, the Utah Medicaid ASD manual (January 2026, read 9/17/2026) does NOT state that ABA is carved out of the ACOs to fee-for-service: it says only that ASD-related medical services go to the MCE and that diagnostic mental-health evaluations/psychological testing are carved out — confirm the ABA carve-out with the Utah Medicaid PA unit (dmhfmedicalpolicy@utah.gov). [9][5]

## At a glance

- **Two products, one name:** SelectHealth Community Care (Medicaid ACO) vs. Select Health commercial (employer/individual)
- **Community Care + ABA:** Carved out to Utah Medicaid FFS — Select Health does not administer it
- **Commercial + ABA:** Select Health's own Policy #630 "Applied Behavior Analysis" (revised eff. 1/1/2026)
- **Commercial prior auth:** Required — ABA Preauthorization Form; 14-day decision in Utah
- **Commercial submission:** commercialUMintake@imail.org · fax 801-442-0825
- **Parent company:** Intermountain Health (Select Health is a wholly owned subsidiary)
- **Utah mandate:** Utah Code § 31A-22-642 — governs individual/large-group commercial plans, not small-group or Medicaid

## First question: which Select Health?

Select Health's own Medicaid Provider Summary describes SelectHealth Community Care as one of three government/managed products it runs alongside Select Health Medicare and Select Health Share, "available to eligible members living in all Utah counties." Its Provider Reference Manual separately defines a "Fee-For-Service Medicaid member" as anyone whose needed service is covered by Medicaid rather than the ACO plan — the same carve-out mechanism our Utah Medicaid guide documents for all four ACOs — and its Appendix B for Community Care states plainly that "Select Health Community Care policies typically align with State of Utah Medicaid policy." Select Health's own published carved-out-services list names mental-health medications, emergency transportation, long-term care, apnea monitors, and dental — it doesn't explicitly name ABA/autism services, so treat the FFS routing as inherited from Utah Medicaid's own carve-out policy (already verified in our Utah Medicaid guide) rather than a Select Health-authored statement. Either way, the operational answer for intake is the same: for a Community Care member, don't call Select Health for ABA — go straight to Utah Medicaid. [1][2][3]

## Commercial members: Select Health's own ABA policy

For employer-group, self-funded, and individual/marketplace members, Select Health runs its own numbered medical policy — Policy #630, "Applied Behavior Analysis (ABA)" — which Select Health's February 2026 Policy Update Bulletin confirms was revised effective January 1, 2026 (the bulletin describes reorganized medical-necessity criteria and removal of an FEHB-plan exception, but the policy PDF itself returned a maintenance error at every attempt during this review — treat specific diagnostic or hour-based criteria as unverified until confirmed directly with Select Health). What is independently confirmed from Select Health's own live 2026 ABA Preauthorization Form: it distinguishes an initial request (diagnostic evaluation report required) from a concurrent/continuation request (updated treatment plan with progress data required), and Utah decisions on commercial plans are due within 14 days absent expedited review. The form also collects a detailed weekly ABA schedule (day, time, setting — office/home/other), school and other-therapy schedules, and IEP/ISP/504/ARD status — build that into your intake packet before submitting. [4][5]

## Submission mechanics by line of business

Select Health's ABA Preauthorization Form routes requests by email, split cleanly by line of business: commercial (large/small employer, self-funded, individual) goes to commercialUMintake@imail.org (fax 801-442-0825); Select Health Community Care (Medicaid/CHIP) goes to medicaidUMintake@imail.org (fax 801-442-0625) — relevant only for the non-ABA services Community Care still administers, since ABA itself routes to Utah Medicaid, not this address; Select Health Medicare goes to medicareUMintake@imail.org (fax 801-442-0302), with a 14-day decision window across all states. Select Health also runs an online "Preauth & Care Plan Tool," where some requests qualify for auto-approval, and a general 24/7 preauthorization help desk at 800-442-4566. General provider support for commercial plans runs through 800-222-6358. [5][6]

## The Utah mandate and commercial market segment

Utah Code § 31A-22-642 requires ASD diagnosis-and-treatment coverage in the individual and large-group markets — small-group plans are not named by the statute. Select Health's own ABA Preauthorization Form lists "Commercial Plans (Large/Small Employer, Self-Funded, Ind.)" as a single routing category, meaning Select Health's ABA intake process is unified across market segments even though the mandate's protections (no age limit, no hour cap for plans entered or renewed since 1/1/2020) legally apply only to individual and large-group business — small-group and self-funded ERISA plans sit outside the mandate. We found no Select Health page that discusses mandate compliance or breaks out market segment explicitly, so confirm a given member's market segment (individual, small-group, large-group, or self-funded) as part of benefits verification rather than assuming mandate protections apply. Also worth knowing: starting before July 1, 2027, Utah requires every health benefit plan — Select Health included — to publicly report autism-assessment wait times, PA practices, and average ABA hours/cost to the Insurance Department annually. [7][5]

## Rates

No Select Health-specific ABA fee schedule (commercial or Community Care) was found published. For Community Care members, ABA rides Utah Medicaid FFS entirely, so the relevant benchmark is Utah Medicaid's own published PRISM rates ($19.67 per 15-minute unit on 97153; $37.51 on 97151/97155/97156, effective 7/1/2026) — not a Select Health rate at all. For commercial members, rates are contract-negotiated and live in your participating-provider agreement. [8]

## Intake gates

The questions that decide whether a family can start with Select Health (Utah), and what they have to bring.

- **Who may diagnose**: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — the diagnosis may be rendered by any clinician authorized under the scope of their licensure and trained in the use and interpretation of the selected assessment tool. For commercial members the Utah mandate's definition is narrower and stricter: a board-certified neurologist, psychiatrist or pediatrician with ASD experience, or an experienced licensed psychologist. [9][11][7]
- **Prior-auth decision time**: Commercial members: Select Health's own 2026 ABA Preauthorization Form sets the clock — "Once Select Health receives this form, we have the following decision time frames to make a benefit determination (unless an expedited review is requested): For Commercial Plans: 14 days (Utah)." Expedited review is available only if the standard time frame could seriously jeopardize life, health or the ability to regain maximum function, or leave severe pain unmanaged. Utah requires fully insured plans' adverse-determination procedures to comply with 29 CFR 2560.503-1, which caps an urgent pre-service decision at 72 hours after receipt. From January 1, 2027 Utah Code 31A-22-650 (SB 319, 2026) tightens insurers to "no later than seven calendar days after the day on which the insurer receives all necessary information," and 72 hours for urgent care. Select Health separately distinguishes an initial request (diagnostic evaluation report) from a concurrent request (updated treatment plan with progress data). Community Care (Medicaid) members: the plan's manual gives 14 calendar days standard and 72 hours urgent for its own preauthorizations, but this guide records ABA as routing to Utah Medicaid fee-for-service, where the state's clock applies instead. [5][2][12][13][14]
  - Ask the plan: Select Health Health Services, 800-442-5305: the reauthorization lead time for ABA concurrent requests, which neither the form nor the manual states.
- **Other insurance (who pays first)**: Commercial members follow the standard order in Select Health's manual, which tracks Utah's COB rule. For a child on both parents' plans, "The benefits of the plan of the parent whose birthday falls earlier in the calendar year are determined before those of the plan of the parent whose birthday falls later in the year" (month and day only; same birthday goes to the plan that covered the parent longer). Divorced or separated parents: a court decree naming the responsible parent controls; joint custody without one uses the birthday rule. "Because of the government's role in subsidizing care for members enrolled in CHAMPUS/TRICARE and MEDICAID, these policies are always considered secondary to another plan" — so Select Health commercial pays before a child's Medicaid or TRICARE. When Select Health is secondary, the COB information must reach it "within 12 months after the claim was processed by the primary plan." Community Care (Medicaid) members: Medicaid is payer of last resort; for ABA routed to fee-for-service, Utah Medicaid's own TPL rules apply (other coverage exhausted first, 6-month transition to an in-network provider). [2][15][9]
- **Age limit** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — no upper age limit, PRISM showing ages 1 and older including adult plans. For Select Health commercial members, the Utah mandate sets the floor where it applies: Utah Code § 31A-22-642 imposes no age limit on individual and large-group plans entered or renewed since 1/1/2020, but small-group plans are not named by the statute and self-funded ERISA plans are exempt. [8][10][7]
  - Ask the plan: A live benefits verification of the member's market segment (individual, small-group, large-group or self-funded) — the mandate's protections do not reach small-group or self-funded business.
- **Referral required?** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — an order or prescription for ABA from a licensed clinician authorized to prescribe it is required in the initial packet and renewed annually. For commercial members, Select Health requires preauthorization on its own ABA Preauthorization Form (commercialUMintake@imail.org, fax 801-442-0825), with Utah decisions due within 14 days absent expedited review; no separate physician referral requirement is published. [9][5]
  - Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
- **Telehealth** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — telehealth covers supervision and parent training but not technician-delivered 97153/97154 or QHP-delivered group 97158, synchronous only, POS 02. For commercial members the form collects a weekly ABA schedule by setting (office, home, other) rather than stating a telehealth rule. [9][11][5]
  - Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).

## Delivery and billing rules

Coverage decides whether Select Health (Utah) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Daily limits / MUEs** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — limits are set per 26-week authorization period, not per day (97153 up to 780 hours; 97155 plus H0032 capped at 84 combined hours). On the commercial side the Utah mandate removed hour caps for individual and large-group plans entered or renewed since 1/1/2020 — the 600-hours-a-year floor survives only on legacy pre-2020 plans — but small-group and self-funded plans sit outside the statute. [9][7]
  - Ask the plan: A live benefits verification — annual maximums and any plan-level hour limits are plan-specific, and Policy #630 could not be retrieved.
- **Place of service** _(plan-dependent)_: For SelectHealth Community Care (Medicaid) members this is not a Select Health question: ABA is carved out of every Utah Medicaid ACO to state fee-for-service, so the Utah Medicaid rule governs — home, community and clinic settings are payable across the same day, while IEP-listed school services route to the School-Based Skills Development benefit instead. For commercial members, Select Health's ABA Preauthorization Form collects a full weekly schedule by setting (office, home, other) plus school and other-therapy schedules and IEP/ISP/504/ARD status, which is how setting is actually adjudicated. [9][5]
  - Blocked on: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566).
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Select Health Policy #630 (Applied Behavior Analysis), revised effective 1/1/2026 — the policy PDF returned a maintenance error at every attempt during review; confirm with Select Health UM (commercialUMintake@imail.org, 800-442-4566). [9][11]

## What intake should collect for Select Health (Utah)

- **Community Care vs. commercial:** The single most important question — ask which product the family is on, or check whether the card says "Community Care" (Medicaid) vs. a standard employer/individual plan.
- **For Community Care members: route to Utah Medicaid:** ABA never touches Select Health for these members — collect the same documents our Utah Medicaid guide describes and submit through PRISM.
- **For commercial members: market segment:** Individual/large-group (mandate applies, no hour cap since 2020) vs. small-group/self-funded (mandate doesn't apply) — ask for the employer and check the card.
- **Diagnostic evaluation report (initial) or updated treatment plan (continuation):** Select Health's commercial ABA Preauthorization Form requires one or the other depending on request type.
- **Weekly ABA schedule + IEP/504 status:** The commercial preauth form asks for a full weekly schedule by setting and school-plan status — gather this before submitting.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Select Health (Utah) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (Availity):** SX107 (Availity Advanced) / HT006873-001 (Availity Basic, via UHIN) — SX107/HT006873-001 come from a WebSearch summary of Select Health's own Payer ID List PDF, corroborated by a second independent source (thepracticebridge.com), but neither was read directly from readable primary-document text this pass — treat as inferred, not verified. IMPORTANT: for a Community Care (Medicaid) member, do NOT use this ID for an ABA eligibility check — route to utah-medicaid's own entry (pVerify 01324) instead, since ABA is carved out to state FFS entirely and Select Health never adjudicates it for these members.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** For Community Care (Medicaid) members: none via Select Health — ABA is carved out entirely to Utah Medicaid FFS, identical to Utah's other three ACOs (see utah-medicaid above); Select Health does not administer or adjudicate ABA for these members at all. For commercial members: Select Health administers ABA in-house under its own Policy #630 — no third-party BH vendor named.
- **BH administrator payer ID:** N/A (Community Care) / unverified (commercial)
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** 30 — Utah Medicaid's own 270/271 companion guide (UT_PRISM_COMPANION_GUIDE, already cited in this guide's edi.medicaid271Notes) states plainly that Utah Medicaid "does not return eligibility at the procedure code level" and defaults to the generic STC "30" (Health Benefit Plan Coverage) bucket — ABA-specific cost-share detail is NOT surfaced on the wire; the FFS carve-out is applied from policy knowledge, not read off the 271.
- **271 response quality for ABA:** low — Seeded 'low': the companion guide's own default-to-STC-30, no-procedure-level-detail statement means a real 271 for an ABA member returns only generic plan-active/inactive information, not service-level financial detail.

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97152 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97153 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97154 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97155 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97156 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97157 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 97158 | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 0362T | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |
| 0373T | Yes — commercial members only, under Select Health's own Policy #630 ("Applied Behavior Analysis (ABA)," revised eff. 1/1/2026). NOT applicable to Community Care (Medicaid) members — see utah-medicaid's codeGrid instead; ABA never touches Select Health for those members. | Required — Select Health's own ABA Preauthorization Form: an initial request needs a diagnostic evaluation report; a concurrent/continuation request needs an updated treatment plan with progress data. Decisions on Utah commercial plans are due within 14 days absent expedited review. | — | office, home, other (per the Preauthorization Form's weekly-schedule field — no CMS POS numbers given) | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Verify via: Select Health commercial UM intake (commercialUMintake@imail.org, fax 801-442-0825) — Policy #630's full medical-necessity criteria were not retrievable this pass; confirm unit caps, POS, and modifiers directly. The Utah Code 31A-22-642 mandate layer (individual + large group only — NOT small group) governs limits for qualifying plans, not coding mechanics.

### Contacts

- **Provider services phone:** 800-222-6358 (general commercial provider support) / 800-442-4566 (24/7 preauthorization help desk)
- **Portal:** [Select Health Preauth & Care Plan Tool](https://selecthealth.org/providers/preauthorization/forms-reports)
- **Fax:** 801-442-0825 (commercial UM intake); Community Care (non-ABA services) 801-442-0625

Questions to ask on a verification call:

- Confirm which product this family is on — SelectHealth Community Care (Medicaid, routes ABA to Utah Medicaid FFS entirely) vs. Select Health commercial (Policy #630, its own PA process) — since the two have completely different ABA workflows.
- For commercial members: what are Policy #630's actual unit caps, POS restrictions, and modifier requirements — the policy PDF itself was not retrievable this pass?
- For commercial members: what market segment is this plan (individual/large-group vs. small-group/self-funded), since only the first two are protected by the Utah Code 31A-22-642 mandate?
- Is telehealth allowed for any ABA codes under the commercial Policy #630, and if so which ones?
- What EDI payer ID should be used for a commercial member's 270/271 eligibility check — SX107 or HT006873-001 — neither was independently confirmed against readable primary-source text this pass?

### VOB data sources

- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/programs/government/medicaid-provider-summary.pdf (accessed 2026-07-23)
- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/Reference%20Manuals/prm-comm-govt.pdf (accessed 2026-07-23)
- https://www.selecthealth.org/content/dam/selecthealth/Provider/PDFs/claims/payer-id-list.pdf (accessed 2026-07-23; source document older than 18 months)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://medicaid-documents.dhhs.utah.gov/Documents/pdfs/EE-Health%20Care%20Eligibility%20Benefit%20Inquiry%20and%20Response%20Companion%20(270,%20271)%20SFY25.pdf (accessed 2026-07-23)
- https://selecthealth.org/providers/policies/policy-update-bulletins/policy-update-0226 (accessed 2026-07-23)
- https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/forms/sh-aba-pre-auth-form.pdf (accessed 2026-07-23)
- https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2026050620260506.html (accessed 2026-07-23)
- https://selecthealth.org/providers/preauthorization/forms-reports (accessed 2026-07-23)

## Common questions

### Does Select Health cover ABA therapy in Utah?

Depends which Select Health. SelectHealth Community Care (the Medicaid ACO) never administers ABA — it rides Utah Medicaid's fee-for-service carve-out. Select Health commercial (employer/individual) plans cover ABA under the plan's own Policy #630, with prior authorization required.

### My client has "Select Health Community Care" — where does the ABA request go?

To Utah Medicaid directly, not to Select Health. ABA is carved out of all four Utah Medicaid ACOs (including SelectHealth Community Care) to state fee-for-service — see our Utah Medicaid guide.

### How do I submit an ABA prior authorization to Select Health commercial?

Select Health's ABA Preauthorization Form, emailed to commercialUMintake@imail.org (fax 801-442-0825 as backup). Decisions on Utah commercial plans are due within 14 days.

### What does Select Health pay for ABA?

No published fee schedule exists for either product. Community Care members' ABA is paid at Utah Medicaid's own PRISM rates (not a Select Health rate); commercial rates are negotiated in your participating-provider agreement.

## Primary sources

1. [Select Health — Medicaid Provider Summary](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/programs/government/medicaid-provider-summary.pdf)
2. [Select Health — Provider Reference Manual (Commercial & Government)](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/Reference%20Manuals/prm-comm-govt.pdf)
3. [Select Health — Medicaid Member Handbook](https://selecthealth.org/content/dam/selecthealth/Medicaid/PDFs/medicaid-handbook.pdf)
4. [Select Health — Policy Update Bulletin, February 2026 (Policy 630 revision)](https://selecthealth.org/providers/policies/policy-update-bulletins/policy-update-0226)
5. [Select Health — ABA Preauthorization Form (2026)](https://selecthealth.org/content/dam/selecthealth/Provider/PDFs/forms/sh-aba-pre-auth-form.pdf)
6. [Select Health — Preauthorization Forms & Reports](https://selecthealth.org/providers/preauthorization/forms-reports)
7. [Utah Code § 31A-22-642 (current, eff. 5/6/2026)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2026050620260506.html)
8. [PRISM Coverage and Reimbursement Lookup (rates & PA flags)](https://health.utah.gov/stplan/lookup/CoverageLookup.php)
9. [Utah Medicaid Provider Manual — Autism Spectrum Disorder Services (updated January 2026)](https://medicaid-documents.dhhs.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Autism%20Spectrum%20Disorder%20Services/AutismSpectrumDisorder.pdf)
10. [ASD Related Services program page](https://medicaid.utah.gov/ltc-2/asd/)
11. [Utah Medicaid Provider Manual — ASD Services (July 2023 edition, archived)](https://web.archive.org/web/20240821082018/https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Autism%20Spectrum%20Disorder%20Services/AutismSpectrumDisorder7-23.pdf)
12. [Utah Admin. Code R590-261-4 — Adverse Benefit Determination Procedure Compliance (Cornell LII mirror; rules.utah.gov blocked)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-261-4)
13. [29 CFR 2560.503-1(f)(2) — Group health plan claim decision timeframes (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
14. [Utah Code 31A-22-650 — Health care preauthorization requirements (version effective 1/1/2027)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S650_2026050620270101.html)
15. [Utah Admin. Code R590-131-6 — Determining Order of Benefits (Cornell LII mirror)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-131-6)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.