University of Utah Health Plans (U of U Health Plans) contracts with physicians and other
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.
- A Medicaid Accountable Care Organization (ACO) plan and network available to eligible Medicaid members all over Utah.
- A commercial narrow network along the Wasatch Front available to employer groups.
- A commercial network available for members who need statewide access in Utah and surrounding areas for their employees.
- A Medicare Advantage HMO plan and network available for eligible Utah Seniors in Salt Lake, Davis, Weber, and Utah counties.
- A Medicare Special Needs plan and network for individuals who qualify for Medicare and Medicaid in Salt Lake, Davis, Weber, and Utah counties.
- 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.
Healthy U Medicaid Denials
Within the last several weeks Healthy U Medicaid discovered that we have denied some procedure codes inappropriately as non-covered. Please reference this list of impacted codes. Healthy U will be adjusting claims to allow the codes that were inappropriately denied. An appeal is not needed. Please note that CES claims edits will still apply and may affect final payment amounts.
HEDIS Provider Guide
Click here to review our HEDIS Provider Guide
Cultural Diversity and Sensitivity Training
Click here for a copy of our Cultural Diversity and Sensitivity Training
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 UpdatesPlease 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
- 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.
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.