Provider Contracting and Credentialing

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 Contract Application and email to Provider Relations, or contact us directly at:

Provider Relations & Contracting
provider.contracting@hsc.utah.edu 
801-587-2838 option 2

 

Please note that we are not accepting applications for any U of U Health Plans Networks 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 contract application and approval 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 U of U Health Plans, 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 universal credentialing application enabling instant access to 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   There is no cost to the provider and the time saving is tremendous.

To initiate credentialing for new providers with a contracted 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#
  • Provider NPI
  • Primary Practice Location
  • Credentialing contact name and email address

(For example John Q. Public, MD – Family Medicine – 01-01-1951 – CAQH 12345678 – NPI 1234567890 – Doctors Medical Clinic – Mary Smith – mary.smithcredentialing@gmail.com)

The dertermination of whether a credentialing applicant is approved or found not to meet their UUHP criteria 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 requires that all Advanced Practice Professionals (APPs) 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, APPs 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.

If you have additional questions, please contact our credentialing team at:

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

If you have an Organizational Provider Credentialing Application to submit, please complete the form and upload the application.
To download the Organizational Provider Credentialing Application, please click here.

Please note, your email address will only be used with this upload to work out any possible transmission problems. 
If you have a question about the file upload process, please call 801-587-6480, Option 2.

If you would like to submit a document for a Credentialing Audit, please complete the form and upload your documents.

Please note, your email address will only be used with this upload to work out any possible transmission problems. 
If you have a question about the file upload process, please call 801-587-6480, Option 2.