Provider Contracting

Provider Application Process

Please note: We are not accepting applications for the specialties listed below.
  • Behavioral Health Providers (in Davis, Utah, & Salt Lake Counties) – Except Psychiatry & Psychology or providers that specialize in working with children.
  • Chiropractic
  • Durable Medical Equipment / Medical Supplies
  • Home Health / Hospice / Personal Care Agencies
  • Home Infusion
  • Laboratories
  • Long–Term Acute Care Hospitals (in Davis, Salt Lake & Utah Counties)
  • Orthotics and Prosthetics
  • Physical Therapy (in Davis, Salt Lake, Utah & Weber Counties)
  • Residential Treatment Center
  • Skilled Nursing Facilities (in Davis, Salt Lake & Utah Counties)
  • Specialty Pharmacy

Step One

Our Contracting Committee reviews applications within 15-20 business days. If the application is not approved, you will be notified. If the application is approved, one of our Contract Executives will extend a contract to you. When we receive the signed contract back from you, we will initiate the credentialing of all of the providers that are listed in Exhibit B. Here is the link to the application: Provider Application Form. If you need to make an update to your practice please use the Provider Information Update Form.

Step Two

Credentialing typically takes 6-8 weeks to complete. The Credentialing Committee is chaired by our Medical Director and they give the final determination if a provider meets our credentialing criteria. This committee meets the first Monday of each month, excluding holidays. Once credentialed, providers may begin to see members.

  • Please include a copy of the business W-9 Tax Form with the application.

Adding a new Provider

If you already have a contract and are adding a new provider, please click on the Provider Credentialing tab (on the left side of page).

Provider Business Update

If you are a provider and need to update your existing business information please use the following Provider Update Form.

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
    • Steward hospitals
    • Physician Group of Utah (PGU)
  • 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 Update Form

Use this form to notify U of U Health Plans about changes in your practice.

Form Instructions

Please contact your Provider Relations representative for any of the following requests:

  • Closing a practice
  • Changing where your payments are directed
  • Terminating a network affiliation for any reason
  • If you are an organization and have changed ownership

For all other updates, submit the following form.

Fields marked with an asterisk ( *) are required fields.

Type of change: *
Changes apply to: *

Your Details

Enter your contact information for this change request:

Last name: * First name: *
Organization name(s):
Email: * Phone: *
Effective date of change: * [mm/dd/yyyy]

Who is this change for?

Updates to existing providers: complete the Old and New information sections
Adding a new provider to your practice: complete only the New information fields

Old Provider IDs New Provider IDs
Last name: Last name:
Middle name: Middle name:
First name: First name:
Organization name(s): Organization name(s):
Provider NPI: Provider NPI:
Organization or clinic NPI: Organization or clinic NPI:
Tax ID: Tax ID:
If your Tax ID is changing, please fax a copy of your signed W-9 tax form to (801) 281-6121 after submitting this online form.

Physical address

Old physical address New physical address
Street address 1: Street address 1:
Street address 2: Street address 2:
Suite: Suite:
City: City:
State: State:
Zip: Zip:
Handicap access: Handicap access:
Phone: Phone:
Fax: Fax:
Email: Email:

Billing address

Billing information same as physical address information above (click to checkmark box if Yes, leave unchecked if No)
Old billing address New billing address
Street address 1: Street address 1:
Street address 2: Street address 2:
Suite: Suite:
City: City:
State: State:
Zip: Zip:
Handicap access: Handicap access:
Phone: Phone:
Fax: Fax:
Email: Email:

Practice information

Accepting new patients? * Yes No
Practice primary care? * Yes No
Print in directory? * Yes No
Specialty: (List all that apply)
Degree(s): (List all that apply)
Other languages: (List all that apply)
Taxonomy code:

Please provide any additional information to assist us locating the appropriate provider record, or information that you require be updated:

Clinic website (optional):

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.

Questions about Plans?

  • 6053 Fashion Square Drive, Suite 110
  • Murray, UT 84107