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Provider Relations & Contracting

Provider Contracting

Provider Networks & Provider Applicant Process

Provider applications to participate in any U of U Health Plan network are considered based on the following:

  • Business needs
  • The credentialing process

All providers must be approved through our credentialing process before they may participate in any network.

Business needs may include and are not limited to:

  • Network adequacy requirements based on state and/or federal guidelines
  • Network adequacy requirements based on the current or expected population of a given geographic area (usually defined by county or zip code)
  • Network adequacy requirements based on provider type and/or specialty
  • Network composition based on scope of services required by payer such as employer, health plan, union/trust, government entity, etc.
  • Network performance requirements in terms of cost/utilization, quality measures, outcomes, access, and/or patient or physician satisfaction
  • Demographic needs including but not limited to languages spoken
  • Existing, non-compensated, referral patterns with current network providers and/or U of U Health Plans members

Benefits of participating with a U of U Health Plan network include:

  • Claim payments made to you directly on a weekly basis
  • Provider Relations representatives are available to help you and your staff
  • Inclusion in our on-line and printed provider directories made available to brokers,employers and members for the applicable products
  • Member benefits are designed to encourage use of network providers
  • Eligibility to register for Provider Portal, our online tool to verify eligibility, check claims status, submit inquiries, and more

Provider Application Process

Note: We are no longer accepting applications for Durable Medical Equipment / Medical Supplies providers, Laboratory / Pathology providers, or Infusion Suite.

To apply, complete the Provider Application Form below.
Our Contracting Committee reviews applications within 15 to 20 business days.

  • If the application is approved, one of our Contracting Executives will extend a contract to you. When we receive the signed contract back from you, we will initiate credentialing of all providers listed in Exhibit B.
  • If the application is denied, you will be notified.

Credentialing typically takes 6-8 weeks to complete following receipt of the signed contract. The Credentialing Committee makes the final determination as to whether the provider meets our credentialing criteria. This committee meets the first Monday of each month, excluding holidays. Once credentialed, providers can being to see members

If you need to make an update to your practice, use the Provider Information Update Form, not a new Application.

Note: Adding a New Provider

If you already have a contract and are adding a new provider, follow instructions under Practitioner Credentialing.

Note: Provider Business Updates

If you need to update your existing location or business information, complete and submit the Provider Information Update Form.


For consideration in one or more of our networks please complete the application process.

Start Application

Provider Relations

  • Provider Relations

    provider.relations@hsc.utah.edu
    801-587-2838 option 2

    • Escalated provider issues
    • Provider contracting questions
    • Claims concerns not addressed by Customer Service

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

  • Emily Bird, Provider Consultant

    emily.bird@hsc.utah.edu

    801-587-2666

    Provider Consultant Map

    Salt Lake County in Utah and all Nevada:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • Pathology labs
    • Dialysis centers
    • Holy Cross Hospitals
    • Holy Cross Medical Group
  • Sandra Campbell, Provider Consultant

    Sandra.campbell@hsc.utah.edu

    801-587-2943

    Provider Consultant Map

    Beaver, Carbon, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Utah, Washington, and Wayne counties in Utah; and all Colorado and Wyoming:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • HCA physicians
    • Anesthesia Groups
    • HCA MountainStar Hospital System
    • Durable Medical Equipment companies
  • Mary Carbaugh, Provider Consultant

    Mary.carbaugh@hsc.utah.edu

    801-587-2920

    Provider Consultant Map

    Box Elder, Cache, Daggett, Davis, Duchesne, Rich, Morgan, Summit, Tooele, Uintah, Wasatch, and Weber counties in Utah; and all Idaho:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • Interpreting Agencies
    • Intermountain Healthcare
    • Skilled Nursing Facilities
    • Home Health, and Hospice
    • Long-Term Acute Care hospitals

Provider Information Update Form

Please include any associated provider(s) and NPI(s) number(s) that we need to have listed under the change. If needed, attach a provider roster, W-9, or other necessary documentation below. This information is required to complete this request.

Anything with a * next to it is a required field.

CONTACT INFORMATION

EXISTING ADDRESS
EXISTING BILLING ADDRESS

PRACTICE INFORMATION

* ASSOCIATED PROVIDER: (IF MULTIPLE PROVIDERS, ATTACH INFORMATION AS A SPREADSHEET OR OTHER FORM OF ROSTER BEFORE SUBMITTING THIS FORM.)
NEW PRACTICE ADDRESS
(PICK ALL THAT APPLY)
Website URL: By providing the URL to your clinic website, you give University of Utah Health Plans permission to publish a link to your site in our provider directories. U of U Health Plans assumes no responsibility or liability for the information displayed on your site.
NEW BILLING ADDRESS

Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: pdf, doc, docx, ppt, pptx, xls, xlsx, xml, zip.