AUGUST 2025
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WHAT'S IN THIS NEWSLETTER?
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- New plan for University of Utah employees and dependents
- 2025 legislative session summary
- Staffing changes @ U of U Health Plans
QUALITY IMPROVEMENT & PATIENT CARE
- To do: submit your ADA attestation
- Complex case management services and referral options
- How you can help improve members' glycemic status
- Schedule a cultural sensitivity training for your team
- Codes requiring prior authorization
- Reminder: always verify Medicaid eligibility
- Statewide Medicaid trainings are available
- Medicaid formulary changes coming January 2026
- New benefit coverage: refraction eye exam and salpingectomy
- Controlled Substance Database (CSD) and opioid prescribing guidelines
- Pharmacy resources
- Medical policy updates
- Reimbursement policy updates
INTRODUCING THE HEALTHY PREMIER U OF U COMMUNITY PLAN—A NEW PLAN FOR UNIVERSITY OF UTAH EMPLOYEES AND DEPENDENTS
Effective July 1, 2025, University of Utah academic employees can choose the Healthy Premier U of U Community plan for their insurance coverage. This plan includes access to the statewide Healthy Premier network for medical care and the Huntsman Mental Health Institute Behavioral Health Network (HMHI BHN) for behavioral health care.
2025 LEGISLATIVE SESSION SUMMARY
We encourage you to review and consider how these bills may affect your operations, documentation, or clinical workflows:
- HB281: Health Curriculum & Procedures Amendments - Requires schools to obtain parental consent before students receive certain health services. If you work with school-based services, you should be aware of these requirements and changes.
- HB452: Artificial Intelligence Amendments - Regulates the use of AI-powered mental health tools, including chatbots. Prohibits sharing individually identifiable health data and requires developers to file policies with the state. Mental health providers using AI tools should review compliance obligations.
- SB65: Medication-Assisted Treatment Amendments - Supports and regulates the use of medication-assisted treatment (MAT) in residential and recovery settings. Clarifies definitions and ensures MAT is in appropriate behavioral health programs.
STAFFING CHANGES AT U OF U HEALTH PLANS
Todd Randall retired from University of Utah Health Plans on May 30, 2025, after 22 years of dedicated service. Todd has been a key leader in behavioral health contracting and a trusted partner to many of you over the years. His knowledge, consistency, and commitment to providers and members alike will be deeply missed.
Taking over Todd’s role is Troy Fuller, who joined our team in May. Troy brings 20 years of healthcare experience, including a decade working directly with primary care physicians and another 10 years at a multi-specialty clinic. Most recently, he served in provider relations and contracting for Health Choice Utah.
TO DO: SUBMIT YOUR ADA ATTESTATION
We’re committed to making sure all members can access the care they need. If you haven’t yet submitted this year’s ADA Compliance Attestation, please complete the short survey as soon as possible. This helps us ensure our directory includes up-to-date information about physical access, accommodations, and equipment for members with disabilities.
SUBMIT YOUR ASSESSMENT AND ATTESTATION FOR ADA COMPLIANCE
COMPLEX CASE MANAGEMENT SERVICES AND REFERRAL OPTIONS
Have you used our care management programs for complex and chronic condition management? Our programs offer:
- Personalized support from registered nurses and licensed clinical social workers
- Education, advocacy, and coordination of healthcare services
- Collaboration with treating providers and primary care physicians (PCPs)
- No out-of-pocket cost for eligible members
To refer a patient, contact us at 801.213.4008, option 2.
SUBMIT YOUR ASSESSMENT AND ATTESTATION FOR ADA COMPLIANCE
HOW PROVIDERS CAN HELP IMPROVE DIABETIC MEMBERS' GLYCEMIC STATUS
Recent quality scores show there’s still room to improve glycemic status for members with diabetes. Routine A1c testing,—along with proper documentation and coding—helps drive better care and outcomes. See this year’s performance and how you can help.
SCHEDULE A CULTURAL COMPETENCY TRAINING FOR YOUR TEAM
Culturally competent care improves communication, trust, and patient satisfaction. We’ve created an optional training to help providers strengthen their skills and deliver more inclusive care.
REMINDER: ALWAYS VERIFY MEDICAID ELIGIBILITY
Member eligibility for Medicaid can change monthly, or even mid-month. Be sure to verify eligibility within 10 days of each visit. PRISM is the preferred verification tool. If you notice discrepancies between PRISM and your records, please email us at uuhpenrollment@hsc.utah.edu.
VIEW OTHER VERIFICATION OPTIONS
2025 STATEWIDE MEDICAID TRAINING NOW AVAILABLE
Utah Medicaid will be offering the 2025 statewide provider training in August and September. For more information, see the May 2025 Medicaid Information Bulletin (MIB).
VIEW OTHER VERIFICATION OPTIONS
MEDICAID FORMULARY CHANGES COMING JANUARY 2026
At the direction of the Utah State Legislature and the Department of Health and Human Services, all Medicaid managed care plans will be required to align formularies with the Utah Medicaid preferred drug list for certain drug classes—and align on utilization management, prior authorization, and clinical criteria for those specific drug classes.
Members currently on non-preferred drugs may need to transition to preferred products. We will notify impacted members and providers as soon as possible, and no later than November 1, 2025. We will work with you to ensure members can get the medication they need. Please contact us with questions.
NEW BENEFIT COVERAGE: REFRACTION EYE EXAM & SALPINGECTOMY
Refraction Eye Exam: Effective May 1, 2025. Determination of refractive state (CPT code 92015) will be covered once per rolling year in addition to the other covered eye exam codes.
Salpingectomy: Effective May 1, 2025. Salpingectomy is covered for female sterilization. Prior authorization is not required, but to ensure correct claims processing, the Sterlization Consent Form must be completed and sent with the claim. This form must be completed at least 30 days, but not more than 180 days, prior to the date of sterilization except in the case of premature delivery or emergency abdominal surgery.
Use the following CPT codes to report this service:
- 58661 - Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
- 58700 - Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
UTAH CONTROLLED SUBSTANCE DATABASE AND OPIOID PRESCRIBING GUIDELINES
The Utah Controlled Substance Database program (CSD) is a prescription monitoring program that helps identify potential cases of drug abuse and over-prescribing. However, many prescribers are not using this valuable resource.
Remember to check the database before prescribing for the first time. And if you're prescribing opioids, consider following these evidence-based interventions to help lower overdose death rates.
PHARMACY RESOURCES
Our medication and pharmacy information is updated regularly. Because we may add or remove drugs from the formulary during the year, we recommend reviewing our website at least once per quarter to see the most recent information.
To help you know where to go, we compiled a webpage of pharmacy resources that might be helpful to you, including a link to our formularies, prior authorization forms, and more.
CODES REQUIRING PRIOR AUTHORIZATION
We regularly review our list of Codes Requiring Prior Authorization and update it as changes occur, including removing codes no longer requiring authorization. Please search this list before scheduling procedures or prescribing durable medical equipment to determine if prior authorization is required.
Also take a moment to view Upcoming Changes to Codes Requiring Prior Authorization to ensure your authorizations for future procedures are also compliant.
MEDICAL POLICY UPDATES
Medical policies for the following services have been recently created or revised:
VIEW A SUMMARY OF CHANGES HERE
REIMBURSEMENT POLICY UPDATES
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