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...
To support a broader statewide initiative, One Utah Health Collaborative, to strengthen colorectal cancer screening access and reduce avoidable claim denials, U of U Health Plans has aligned preventive screening...
Starting in Measurement Year 2025, the NCQA has transitioned the HEDIS® Cervical Cancer Screening (CCS) measure to the Electronic Clinical Data Systems (ECDS) reporting method. This shift has important implications...
Our medication and pharmacy information is updated as changes occur. Please visit our pharmacy website at least quarterly to view the most recent information. For the 2026 year, a list...
We are dedicated to ensuring our members have timely access to the services they need. Providers participating in one or more of our networks are expected to ensure members have...
As part of our commitment to compliance and accurate reporting, we would like to remind providers of the billing requirements for Provider Preventable Conditions (PPCs) and Hospital-Acquired Conditions (HACs). Federal...
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...
Utah Medicaid is reporting an increase in balance billing referral cases to the Utah Office of Inspector General (OIG). Balance billing Healthy U Medicaid members, or any other Medicaid managed...
University of Utah Health Plans requires prior authorization for all elective inpatient stays as well as certain outpatient services. To better support our members in accessing the care they need...
When University of Utah Health Plans is the secondary payer, providers must ensure that claims are submitted with complete and accurate information to avoid processing delays or denials.
The federal No Surprises Act requires health plans to verify the accuracy of provider directory information every 90 days. In addition to staying compliant, an accurate provider directory ensures our...
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 has formed a new partnership with Previon Inc. to provide convenient at-home colorectal cancer screening through mail-delivered FIT (Fecal Immunochemical Test) kits. Implementation is underway...
In order to avoid denials, Healthy U is clarifying billing guidelines for monthly medical supplies. On August 11, 2025, Healthy U started applying the following logic: Medical supplies filled on...
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...
Beginning January 1, 2026, Medicaid managed care plans (Healthy U, Health Choice Utah, Molina Healthcare, and Select Health Community Care) will be required to align their formularies with the Utah...
Incidents of domestic abuse, neglect, and exploitation traditionally escalate during the holidays. Unfortunately, law enforcement and other protective agencies continue seeing a marked increase in domestic violence compared to previous...
U of U Health Plans will continue covering COVID-19 vaccinations for both adults and children as a routine immunization benefit. We recognize ongoing ambiguity in current federal recommendations; however, our...
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...
The Utah Controlled Substance Database program (CSD) is a prescription monitoring program that is a resource for you to identify potential cases of drug abuse and over-prescribing. However, many prescribers...
As our communities grow, the ability to provide culturally competent care has become essential for healthcare professionals. Cultural competency not only enhances communication and trust between providers and patients—it also...
