Accurate provider information is essential for smooth claims processing, timely payment, and ensuring members can find appropriate care. However, the demographic information required for billing claims is not the same...
When submitting claims with Place of Service (POS) 99 – Other Place of Service, it is essential to clearly document where the services were actually rendered. POS 99 is used...
Utah’s 2026 General Session introduced several significant changes affecting provider directories, insurance coverage requirements, autism services, and physical therapy cost sharing. Below is a summary of key bills and their...
To ensure accurate and timely claims processing, we want to remind all providers of the correct billing requirements when patients are seen in multiple locations. When a patient receives care...
U of U Health Plans prefers to receive corrected claims via EDI transaction. To request a corrected claim, submit the following information in Loop 2300 of an 837I (Institutional) or...
In risk adjustment reporting, documentation is interpreted using the ICD-10-CM Official Guidelines for Coding and Reporting. These guidelines outline when coders may presume relationships between conditions and when they may...
University of Utah Health Plans uses medical policies as guidelines for coverage determinations in accordance with the member’s benefits. Quarterly notice of recently approved and revised medical policies is provided...
In the various workshops, presentations, and surveys we conduct throughout each year, appeals is one topic that always raises questions. Here are some of the most common appeal issues we...
Individual and Family Plans offered on and off the Individual Marketplace Exchange use the Healthy Premier and U Health Plus networks. • Healthy Premier is a statewide network. • U...
University of Utah Health Plans uses medical policies as guidelines for coverage determinations in accordance with the member’s benefits. Quarterly notice of recently approved and revised medical policies is provided...
University of Utah Health Plans uses medical policies as guidelines for coverage determinations in accordance with the member’s benefits. Quarterly notice of recently approved and revised medical policies is provided...
Recent federal updates to childhood vaccination recommendations have led to increased discussion—and some confusion—regarding which vaccines are advised for all children versus those recommended based on shared clinical decision-making or...
