Utah Medicaid — Utah Medicaid (Integrated Plans / ACO model)
| Program name | Utah Medicaid (Integrated Plans / ACO model) |
|---|---|
| Provider portal | https://medicaid.utah.gov |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Utah Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Utah
The Blue Cross Blue Shield Association licensee in Utah is Regence BlueCross BlueShield of Utah. See the Regence payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Utah
The dominant commercial insurers operating in Utah, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Utah
Utah Medicaid (Integrated Plans / ACO model) contracts with the following managed-care organizations to administer Medicaid benefits in Utah. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
Medicare contractor and active LCDs in Utah
Noridian Healthcare Solutions, LLC is the Medicare A/B MAC for Utah: Part A and Part B fee-for-service claims from Utah go to it, and its Local Coverage Determinations decide local medical necessity. Durable medical equipment and supply claims go to Noridian Healthcare Solutions, LLC as the DME MAC. Home health and hospice claims are processed by CGS Administrators, LLC. In the current Medicare Coverage Database export, 172 active LCDs from these contractors apply to Utah claims.
- Noridian Healthcare Solutions, LLC
A/B MAC (Part A and Part B claims); DME MAC (durable medical equipment and supplies)
- CGS Administrators, LLC
Home health and hospice MAC
Selected active Noridian Healthcare Solutions, LLC policies for Utah
A selection, not the full list: policies with measured search demand come first, then those on topics that more contractors publish LCDs for.
- L38814 MolDX: Minimal Residual Disease Testing for Cancer
- L39240 Epidural Steroid Injections for Pain Management
- L38902 Wound and Ulcer Care
- L34211 Trigger Point Injections (TPI)
- L35526 B-type Natriuretic Peptide (BNP) Testing
- L38709 Computed Tomography Cerebral Perfusion Analysis (CTP)
- L40255 Temporary Nontherapeutic Ambulatory Cardiac Monitoring Devices
- L34194 Blepharoplasty, Eyelid Surgery, and Brow Lift
- L34215 Lab: Flow Cytometry
- L35136 Spinal Cord Stimulators for Chronic Pain
- L36538 Treatment of Males with Low Testosterone
- L36678 Lab: Bladder/Urothelial Tumor Markers
Equipment, home health and hospice policies that apply in Utah
- L33822 Glucose Monitors
- L33789 Power Mobility Devices
- L33318 Knee Orthoses
- L33686 Ankle-Foot/Knee-Ankle-Foot Orthosis
- L33718 Positive Airway Pressure (PAP) Devices for the Treatment of Obstructive Sleep Apnea
- L33792 Wheelchair Options/Accessories
- L33797 Oxygen and Oxygen Equipment
- L33942 Physical Therapy - Home Health
Steps to confirm which LCD governs a claim · Every active LCD by contractor
State-specific regulations affecting Utah billing
- Utah Code §31A-22-649.7 (prompt pay — 30 days electronic clean claim)
- Utah Code §31A-22-650 (air ambulance balance billing protections; limited surprise billing — federal NSA primary)
- Utah Code §26-21-28 (hospital financial assistance)
Provider licensing & enrollment in Utah
Providers enroll via Utah Medicaid PRISM Provider Enrollment (Conduent). ACOs/Integrated Plans credential via CAQH ProView.
Major health systems headquartered in Utah
| Health system | Headquarters |
|---|---|
| Intermountain Health | Salt Lake City, UT |
| University of Utah Health | Salt Lake City, UT |
| MountainStar Healthcare (HCA) | Salt Lake City, UT |
| CommonSpirit / Holy Cross Network (Utah) | Salt Lake City, UT |
| Ogden Regional Medical Center (MountainStar / HCA) | Ogden, UT |
Frequently asked questions — Utah billing
What is the Utah Medicaid program called?
Utah's Medicaid program is known as Utah Medicaid (Integrated Plans / ACO model). Providers enroll and manage claims through the provider portal at https://medicaid.utah.gov.
What is the Utah Medicaid timely filing limit?
Utah Medicaid (Integrated Plans / ACO model) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Utah's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Utah Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Utah Medicaid (Integrated Plans / ACO model). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Utah?
The dominant commercial payers in Utah include SelectHealth, Regence, UnitedHealthcare, Aetna, Cigna, along with the BCBS licensee Regence BlueCross BlueShield of Utah. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Utah?
Utah Medicaid (Integrated Plans / ACO model) contracts with 4 Medicaid MCOs tracked in the QuickIntell registry, including SelectHealth, Molina Healthcare, Anthem (Elevance Health), Health Plan of Nevada. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Utah?
Utah has 3 tracked state-level statutes that affect medical billing and RCM: Utah Code §31A-22-649.7 (prompt pay — 30 days electronic clean claim); Utah Code §31A-22-650 (air ambulance balance billing protections; limited surprise billing — federal NSA primary); Utah Code §26-21-28 (hospital financial assistance). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Utah with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Utah Medicaid (Integrated Plans / ACO model) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Utah Medicaid and the member ID card before submission.