Prior Authorization

Pinnacol Assurance lets our SelectNet providers stay focused on patient care.

Prior Authorization is required only for the procedures/services noted below.

Before providing any medical care, please verify that the claim is open, active, and eligible for medical benefits by going to our online system.

If you are a SelectNet provider who has not yet registered to use our online system, request a user ID and password today by calling 303.361.4953 or by printing, completing, and faxing this form.

Prior authorization is required for the following procedures and services:

• All surgeries and procedures within the first 20 days of the date of injury
• Any treatment or procedure not covered in the DOWC’s medical treatment guidelines
• Any previously denied service or procedure
• Spine procedures/surgeries
• Total joint replacement surgeries
• Multiple body part surgeries
• Second surgeries (same body part)
• Implantable pumps
• Referrals outside of the SelectNet Network

Home Health Care/Durable Medical Equipment (DME) Items and Services Requiring Prior Authorization:

• Prosthetics
• Home health care
• IF2 and galvanic muscle stimulators
• Wheelchair purchase
• Wheelchair rental longer than three months
• Home infusion therapy
• Lifts (hydraulic)
• Oxygen
• Hospital bed purchase
• Hospital bed rental longer than three months
• Any DME with a cost over $1,500

Prior authorization is not necessary for any diagnostic testing, including imaging, referrals, or treatments that comply with the medical treatment guidelines of the Colorado Division of Workers’ Compensation (DOWC).

Any treatment or procedure that is not included in the Medical Treatment Guidelines still requires prior authorization. If you have questions, please contact Pinnacol's medical operations team by calling 303.361.4945.