Provider Home

University of Utah Health Plans (U of U Health Plans) contracts with physicians and other health care professionals and facilities to offer provider networks essential to the delivery of health care and services to our members. UUHP is committed to the “quadruple aim” of improving the patient and provider experience, improving the quality of care and the health of populations, and reducing the cost of care.

We recognize the importance of population health and payment reform and have developed extensive care management and value-based payment programs that improve health and align provider reimbursement with value and positive outcomes.  

 

Healthy U Medicaid

        - A Medicaid Accountable Care Organization (ACO) plan and network available to eligible Medicaid members in Box Elder, Cache, Davis, Morgan, Salt Lake, Summit, Tooele, Utah, Wasatch, and Weber counties. 

Healthy Preferred 

        - A commercial narrow network along the Wasatch Front available to employer groups. 

Healthy Premier

        - A commercial network available for members who need statewide access in Utah and surrounding areas for their employees.

Grand Valley Preferred

        - A commercial network created to serve employer groups within and around Grand Junction, Colorado.

Healthy Advantage Plus HMO Medicare

        - A Medicare Advantage HMO plan and network available for eligible Utah Seniors in Salt Lake, Davis, Weber, and Utah counties.  

Healthy Advantage SNP Medicare
        - A Medicare Special Needs plan and network for individuals who qualify for Medicare and Medicaid in Salt Lake, Davis, Weber, and Utah counties.  

H.O.M.E.
        - A Coordinated Health Care Model, in partnership with the University Neuropsychiatric Institute, to meet the medical and mental health needs of people with developmental disabilities. This plan utilizes the Healthy U network.  

What's New? 

Cultural Diversity and Sensitivity Training

  • Click here for a copy of our Cultural Diversity and Sensitivity Training 


Submit Claims

  • Submit claims for all University of Utah Health Plan members including Healthy Advantage and Healthy Advantage Plus to the following address:

    University of Utah Health Plans
    Attention: Claims Department
    PO Box 45180
    Salt Lake City, UT 84145-0180


Why Screen Children for Lead? 

There is no safe blood lead level in children. No measurable level of blood lead is known to be without adverse effects, and once shown, the effects appear to be irreversible without intervention.

Lead screening is required for all Medicaid children:

The Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend a lead risk assessment and a blood lead level test for all Medicaid eligible children between the ages of 6 and 72 months. This component of the CHEC screening is mandated by federal rules. All children ages 6 to 72 months of age are considered at risk for lead poisoning and must be screened

  • Complete a verbal risk assessment for all Medicaid-eligible children ages six to 72 months at each CHEC screening.
  • Complete a blood lead level test for children at 12 and 24 months, anytime from 24 to 72 months when the child has not had the test, or whenever the verbal assessment indicates the child is at high risk for lead poisoning. If a child has not received a blood lead level test, the child must receive it immediately, whether classified high or low risk based on the verbal assessment.

Sources of Lead in Utah

Lead-contaminated water, soil, and paint are the most common sources of children’s lead exposure. Dust from deteriorating lead-based paint is the largest contributor to the lead problem. Homes built prior to 1978 may contain lead paint. Homes built prior to the 1950’s are at particular risk especially if there is chipped or peeling paint or are undergoing renovations. Another environmental source of lead in Utah is soil containing particles of lead from mining. Homes built near or on mining or smelting waste is a significant source of lead in children. 


Important Network Updates

Please note that we are not accepting applications for any U of U Health Plans plan for the specialties listed below.
  • Mental Health (Davis & Salt Lake Counties)
  • Home Health/Hospice
  • Durable Medical Equipment/Medical Supplies
  • Laboratory
  • Skilled Nursing Facilities
  • Long-Term Acute Care Hospitals (Davis, Salt Lake, and Utah Counties)
  • University Health Care Plus network is closed for all provider types.

Healthy Premier Expansion

University of Utah Health Plans is excited to announce we are expanding our Healthy Premier network statewide.  Please see Join Our Network if you are interested in participating in this expanded network.


ICD-10

If you are looking for ICD-10 education please visit UHIN.  University of Utah Health Plans is working with our vendors to ensure we are ready for ICD-10.  

Become Part of the University Of Utah Health Plans Network

If you are interested in joining one of the University of Utah Health Plans networks, please complete the provider applicant form and email to Provider Relations, or contact us directly at:

Provider Relations & Contracting
provider.relations@hsc.utah.edu 
801-587-2838

 

Please note that we are not accepting applications for any U of U Health Plans plan for the specialties listed below.

  • Mental Health (Davis & Salt Lake Counties)
  • Home Health/Hospice
  • Durable Medical Equipment/Medical Supplies
  • Laboratory
  • Skilled Nursing Facilities
  • Long-Term Acute Care Hospitals (Davis, Salt Lake, and Utah Counties)

Todd Randall, Provider Contracting Executive

Todd.randall@hsc.utah.edu

801-587-2774

  • Negotiates contracts with all providers in the state of Utah and surrounding areas

 

Brenda Groves, Provider Contracting Executive

Brenda.groves@hsc.utah.edu 

801-587-2881

  • Negotiates contracts with all providers in the state of Utah and surrounding areas

Sandra Campbell, Provider Consultant

Sandra.campbell@hsc.utah.edu

801-587-2943

Provider Consultant Map

Provider relations for:

  • Professional Providers including physicians, practitioners, physical therapy providers, chiropractic, behavioral health providers, audiologists, podiatrists, optometrists, dentists:

South of 5300 South in Salt Lake County and Utah County.

  • HCA MountainStar Hospital System
  • HCA /Parallon Enrollments
  • IASIS Hospitals
  • Physician Group of Utah (PGU)
  • Independent Hospitals
  • Ambulatory Surgical Centers
  • Durable Medical Equipment companies
  • Pathology labs
  • Anesthesia Groups

 


Mary Carbaugh, Provider Consultant

Mary.carbaugh@hsc.utah.edu 

801-587-2920

Provider Consultant Map

Provider relations for:

  • Professional Providers including physicians, practitioners, physical therapy providers, chiropractic, behavioral health providers, audiologists, podiatrists, optometrists, dentists:
  • North of 5300 South in Salt Lake County; Box Elder, Weber, Davis, Summit, Wasatch, and Tooele counties.
  • Shriners Hospital
  • Intermountain Health Care
  • Mountain West Medical Center
  • Multiplan
  • Dialysis Centers
  • Home Health, Hospice
  • Skilled Nursing Facilities
  • Ambulance companies
  • Interpreting Agencies
  • LTACS

Provider Credentialing
provider.credentialing@hsc.utah.edu 
801-587-2838 Option 3

Providers must complete the provider application and contracting process prior to credentialing with University of Utah Health Plans. 

Our credentialing team has recently collaborated with National Committee for Quality Assurance (NCQA) certified Credentials Verification Organization (CVO) CredSimple, and CAQH ProView, the trusted electronic solution and industry standard for universal credentialing applications, in order to offer our providers an efficient credentialing process enabling them to minimize the time between contracting with UUHP, and providing services to our members.

To allow our credentialing team to access the CAQH applications for your group, please visit the CAQH site at www.caqh.org and grant permission to University of Utah Health Plans to receive your providers’ applications. If your providers have not completed their one-time credentialing application enabling multiple healthcare organizations nationwide, we encourage them to do so at no cost to them, resulting in time savings for you, by going to the following link: http://www.caqh.org/sites/default/files/solutions/proview/guide/PR-QuickRef.pdf

Or if you prefer, contact our credentialing team to have them create CAQH accounts for your providers, after which CAQH will contact them to complete their application for all healthcare organizations you have authorized to view it. There is an additional online application option through CredSimple for providers who prefer to use it.

To initiate credentialing for new providers with your practice, simply send the following to our credentialing team at the email address below:

  • Provider’s first and last names with middle initial
  • Provider’s title
  • Provider’s specialty
  • Provider’s date of birth
  • Provider’s CAQH#, or request for us to create one

(For example John Q. Public, MD – Family Medicine – 01-01-1951 – CAQH 12345678) 

The decision to accept or reject a practitioner’s application is based on information generated through primary source verifications, complaints and grievances, malpractice history, board certifications and peer recommendations. Other sources of information may be considered as appropriate and relevant. 

Initial credentialing and re-credentialing every three (3) years is required for all physicians and other types of health care professionals practicing under their own license as permitted by state law.

University of Utah Health Plans (UUHP) require that all PAs and other mid-level providers complete credentialing.  Once PAs are credentialed, they must submit claims under their own name and NPI for our commercial plans.  For Healthy U Medicaid, PAs will need to submit claims under the supervising physician as this is a requirement of State Medicaid.  All other mid-level providers will need to submit claims under their own name and NPI for both commercial and Healthy U Medicaid.