Provider Contracting
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Provider Contracting
Provider Contracting
providercontracting@hsc.utah.edu
801-587-2838 option 4- Provider Application Form - * Incomplete Applications will be denied
- Provider Information Update Form
Note: We are no longer accepting applications for Durable Medical Equipment / Medical Supplies providers.
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Todd Randall, Provider Contracting Executive
Utah: Salt Lake County
Provider Contracting Executive Territory Map
- Labs
- Dialysis centers
- Behavioral Health Facilities
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Stephanie Haws, Provider Contracting Executive
Utah: Beaver, Carbon, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Utah, Washington, & Wayne counties
Colorado & Wyoming
Provider Contracting Executive Territory Map
- Anesthesia
- Durable Medical Equipment
- Single Case Agreements
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Brenda Groves, Provider Contracting Executive
Utah: Box Elder, Cache, Daggett, Davis, Duchesne, Rich, Morgan, Summit, Tooele, Uintah, Wasatch, & Weber counties
Idaho
Provider Contracting Executive Territory Map
- Interpreting Agencies
- Skilled Nursing Facilities
- Home Health, and Hospice
- Long-Term Acute Care hospitals
Provider Application Process
Step One
To apply, complete the Provider Application form and email it to providercontracting@hsc.utah.edu, or fax the completed form to 801-281-6121.
Note: Incomplete Applications—Including degree (e.g. MD, APRN), hospital privileges/admitting plan, Group and Individual NPI (where indicated), Organization’s Medicare and Medicaid enrollment numbers, and W-9 Taxpayer Identification Form—will be denied.
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 the credentialing of all providers listed in Exhibit B.
- If the application is denied, you will be notified.
If you need to make an update to your practice, use the Provider Information Update Form, not a new Application.
Step Two
Credentialing typically takes 6-8 weeks to complete. The Credentialing Committee makes the final determination as to whether a provider meets our credentialing criteria. This committee meets the first Monday of each month, excluding holidays. Once credentialed, providers can begin to see members.
Adding a new Provider
If you already have a contract and are adding a new provider, please click on the Provider Credentialing tab (in the provider navigation bar, above), and follow the steps under “Where to Start? Let’s Get Started.”
Provider Business Updates
If you need to update your existing location or business information, complete and submit the Provider Information Update Form..
Provider Relations
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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
801-587-2666
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
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Sandra Campbell, Provider Consultant
801-587-2943
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
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Mary Carbaugh, Provider Consultant
801-587-2920
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