.

Appeal Rights

Medicaid: Appeals must be received within 60 days from the date on Notice of Action or EOB.

Neurobehavioral HOME:  Appeals must be received within 60 days from the date on the Notice of Action or EOB. 

UHCP, UUHP Group, and Individual Plans Appeals: Members have 180 days to appeal from Notice of Action Letter/EOB.

UNI & Miners: Please contact appeal coordinators at 801-213-4008 or 833-981-0213. 

Please note: Effective January 1, 2016, the University of Utah Health Plans (U of U Health Plans) will require that providers obtain consent from a Healthy U or UHCP member, to appeal on their behalf, for denied claims or referrals, relating to clinical services. A Clinical appeal means services that were denied in a pre-service review, or services that were billed and require medical review, that were denied.   

To File an Appeal

You, your legally authorized representative or your provider may file your appeal. If you need help filing your appeal, call us at 801-213-4008. If you are deaf or hard of hearing, you can call Utah Relay Services at 711 or 1-800-346-4128.

Appeal Form

Healthy U Medicaid Appeal Form

Healthy U Medicaid Retail Pharmacy Appeals Form

Healthy U Medical Appeals Process

Español

Si necesita esta carta en Español, por favor llamenos al 801-213-4008 o 1-833-981-0213 opcion 1.  Si habla español, puede llamar a Spanish Relay Utah al 1-888-346-3162. These are free public telephone relay services or TTY/TDD. Estos son servicios gratuitos de retransmisión telefónica pública o TTY / TDD.

Submission Information:

Send the complete written appeal to this address:

Appeals Team
6056 Fashion Square Dr., Suite 3104
Murray, UT 84107

Or you can fax to 801-587-9985

Response Time

How long will it take for a decision to be made?

Medicare Advantage: 60 calendar days. Commercial:  45 calendar days.  Medicaid:  30 calendar days.  

If you or your provider believes your life or immediate health is in danger, you may ask for an expedited (quick) appeal by calling Customer Service at 801-213-4008. If we agree the decision needs to be made quickly, we will make a decision in three calendar days for U of U Health Plans/Group and Individual Plans or 72 hours for Healthy U Medicaid.

For Routine or Expedited Appeals:  Sometimes we may need more information. If so, we may take an additional 14 calendar days to make our decision. If we need to take extra time, we will send you a letter.  If you have U of U Health Plans Group or Individual Plans, we will call you to explain why we need more time.  We need your permission to take the extra time for the appeal review.