Updates, Forms, Newsletter, Education & more.

Resources

Updates, Forms, Newsletter, Education & more.

Resources

On This Page

Printable PDF Forms
Reference & Training Healthy U CHIP Provider Manual Print PDF Form
Reference & Training Identifying Our Members Flyer Print PDF Form
Credentialing Facility Credentialing Infographic Print PDF Form
Credentialing Provider Credentialing Infographic Print PDF Form
Credentialing Organizational Provider Credentialing Application Print PDF Form
Credentialing Credentialing Policy Print PDF Form
Credentialing Denial, Termination and Fair Hearing Plan Policy Print PDF Form
Preservice Authorization Request for Preservice (Prior Authorization) Print PDF Form
Preservice Authorization Request for Inpatient, ICF, SNF, Acute Rehab and LTAC Print PDF Form
Preservice Authorization Request for Behavioral Health/Substance Treatment Print PDF Form
Claims & Appeals Request to Reopen an Organizational Determination for Medical Review Print PDF Form
Preservice Peer to Peer Review Request Form (PDF) Print PDF Form
Preservice Peer to Peer Review Request Form - Pharmacy (PDF) Print PDF Form
Claims & Appeals Consent Form Print PDF Form
Claims & Appeals Healthy U Sterilization Hysterectomy Form Cover Sheet Print PDF Form
Claims & Appeals Medical Claim Form Print PDF Form
Member Support Authorization for Release of Information Print PDF Form
Reference & Training Healthy U Behavioral Preferred Practice Guidelines Print PDF Form
Claims & Appeals Open Negotiation Form (No Surprises Act) Print PDF Form
Preservice Upcoming Changes to Codes Requiring Prior Authorization Print PDF Form
Claims & Appeals EDI Form for 835, 837 (Trading Partner Setup) & EFT Enrollment (Electronic Funds Transfer) Print PDF Form

References & Training

Resource Description Link
Provider Portal Training A guide on using the Provider Portal for verifying members, preservice authorizations, claims, and managing your office rosters. View Presentation
Understanding and Navigating Prior Authorizations & Appeals A comprehensive training presentation created by University of Utah Health Plans Provider Relations to guide healthcare providers through the processes of prior authorizations and appeals. View Presentation
Fraud, Waste & Abuse Provider Training

After completing this training, you should be able to:

  • Understand the definitions of fraud, waste, and abuse (FWA) as they pertain to state and federal healthcare programs
  • Recognize laws, regulations, and penalties related to FWA
  • Recognize methods of preventing, detecting, and correcting FWA
  • Know how to report suspected FWA
 Download or View Training
Cultural Sensitivity Training Cultural competency is the ability to understand, respect, and communicate with individuals from diverse cultural backgrounds. Download Training
Doula Services Training A comprehensive guide to doula services available through University of Utah Health Plans, including eligibility, certification, and billing requirements. This resource helps doulas and healthcare providers navigate contracting, claim submission, and benefit limits. Download Training

Clinical Practice Guidelines

Position Statement: University of Utah Health Plans adopts guidelines to help practitioners and members make decisions about appropriate care for specific medical and behavioral health conditions. The following guidelines are based on scientific evidence, and where evidence is lacking, on a consensus of panel experts, and are supported by University of Utah Health Plans. Guidelines are not a substitute for professional medical advice.

Behavioral Health Guidelines

Category Resource
Depression APA Clinical Practice Guideline for the Treatment of Depression
Perinatal Depression Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum
Attention Deficit Hyperactivity Disorder (ADHD)- Pediatrics Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Attention Deficit Hyperactivity Disorder (ADHD)- Adults European Consensus Statement for the Diagnosis, Management, and Treatment of Adult ADHD
Substance Use Disorder American Academy of Family Physicians Management of Substance Use Disorders
Substance Use Disorder – Level of Care Criteria American Society of Addition Medicine (ASAM) Level of Care Placement Criteria
Opioid Prescribing CDC Guideline for Prescribing Opioids for Chronic Pain

Medical Guidelines

Category Resource
Asthma Global Initiative for Asthma (GINA) Report, Global Strategy for Asthma Management and Prevention
Congestive Heart Failure Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Failure Society of America
Hypertension Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report from the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Low Back Pain AAFP Clinical Recommendations- Imaging for Low Back Pain- Choosing Wisely®
Diabetes and Kidney Disease Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guideline for Diabetes and Chronic Kidney Disease

Preventive Health Guidelines - Child

Preventive Health Guidelines - Adult

 

 

 

Provider Connection Newsletters

If you haven’t already, please subscribe—via the link at the bottom of the page—to receive notice when new editions are available. Encourage others in your office to subscribe to receive notice, as well. From clinical to administrative, there’s something for everyone.

 

Networks

Healthy U Medicaid

  • A Medicaid Accountable Care Organization (ACO) plan and network available to eligible Medicaid members all over Utah.

Healthy U CHIP

  • A statewide provider network, effective July 1, 2024, to support the Children's Health Insurance Program, a state-sponsored physical and behavioral health insurance plan for children who do not have other insurance.
    The Healthy U CHIP Provider Manual is available for download. 

    Healthy U CHIP Provider Manual

Healthy U Behavioral

  • Healthy U Behavioral exists for ANY Medicaid-eligible Summit County resident, regardless of their medical coverage.

Healthy Preferred

  • A commercial narrow network along the Wasatch Front available to employer groups.

Healthy Premier

  • A commercial network available for members who need statewide access in Utah and the surrounding areas for their employees.

U Health Plus

  • A narrow network featuring University of Utah Health Hospitals and Clinics, and supplemented with strategic partners to ensure members have adequate access to services. Only Health Insurance Marketplace® Individual/Family members within the targeted footprint in Salt Lake County are eligible to use the U Health Plus network.