Medical Billing Services in Utah
Billing, coding, credentialing and denial management for Utah practices, with Medicare claims through Noridian Healthcare Solutions (Jurisdiction JF) and Utah Medicaid handled by people who know the rules.
Medical billing for Utah practices
Utah's payer market is shaped by integrated health systems. Select Health, owned by Intermountain Health, and University of Utah Health Plans both sell commercial coverage and run Medicaid plans, and Regence BlueCross BlueShield of Utah is the other major commercial carrier. Medicaid physical health care for most members runs through accountable care organizations, while behavioral health and some rural members follow different rules. Medicare Part B claims go to Noridian under Jurisdiction F.
SFA Solutions works with Utah practices remotely, from the Wasatch Front to St. George and the rural counties in between. We keep each ACO's authorization and billing rules straight, file Medicaid claims through PRISM or the plan well inside the 365-day limit, and follow up on commercial denials until they are paid or closed.
Utah at a glance
| Medicare contractor | Noridian Healthcare Solutions, Jurisdiction JF |
|---|---|
| Medicaid timely filing | 365 days from the date of service for fee-for-service claims (from the claim end date for institutional claims); ACOs set filing limits in their provider contracts |
| NP practice authority | Full |
| Cities we serve | Salt Lake City, West Valley City, Provo, Orem, West Jordan, St. George, Ogden, Sandy, Logan, Lehi |
What Utah billing involves
These are the programs and rules our team works with for Utah claims.
Medicare
Noridian Healthcare Solutions · JFUtah Part B claims are processed by Noridian Healthcare Solutions in Jurisdiction JF. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Utah Medicaid
Utah Medicaid, administered by the Utah Department of Health and Human Services (DHHS), including the adult expansion group
Portal: PRISM, Utah Medicaid's claims and provider enrollment system, used for enrollment, claim corrections and remittance advice
Medicaid managed care
Most members receive physical health care through an accountable care organization: Health Choice Utah, Healthy U (University of Utah Health Plans), Molina Healthcare of Utah or Select Health Community Care. Behavioral health is often handled by separate prepaid mental health plans or integrated plans depending on the county, and some members remain fee-for-service.
Timely filing
365 days from the date of service for fee-for-service claims (from the claim end date for institutional claims); ACOs set filing limits in their provider contracts.
Commercial and Medicare Advantage
Select Health, Regence BlueCross BlueShield of Utah and University of Utah Health Plans hold most of the commercial market, with Aetna, Cigna and UnitedHealthcare also active. Select Health, Humana and UnitedHealthcare are major Medicare Advantage carriers.
Prompt pay law
Utah's health care claims practices statute (Utah Code Section 31A-26-301.6) sets a deadline for insurers to pay or deny clean claims and requires interest on late payments; check the current statute text for the exact timeframe.
Nurse practitioners
Full practiceUtah nurse practitioners have full practice authority, so they can credential with Medicaid ACOs, Medicare and commercial plans under their own NPI without a physician agreement. Medicare pays 85% of the physician fee schedule for services billed under the NP's own NPI.
Credentialing
Providers enroll with Utah Medicaid through PRISM, then credential separately with each ACO they want to see members from. Select Health, Regence and most commercial payers rely on CAQH ProView, so the profile should stay current and attested. Medicaid enrollment must be revalidated at least every five years.
Billing challenges Utah practices face
ACO and behavioral health carve-outs
A member's physical health claim may go to an ACO while a mental health service goes to a different plan or fee-for-service Medicaid. Billing the wrong entity is a common Utah Medicaid denial, so eligibility and plan assignment need checking at every visit.
Health system plan rules
Select Health and University of Utah Health Plans often run narrow networks and their own medical policies. Network status and authorization requirements must be confirmed per product before the visit.
Rural and frontier access
Practices serving rural counties see more travel, telehealth and cross-border patients from Idaho, Nevada and Arizona. Telehealth claims need the correct place of service code, such as POS 10 for a patient at home, and the right modifier for each payer.
Our services in Utah
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Utah
Utah medical billing questions
What is the timely filing limit for Utah Medicaid?
Utah Medicaid requires fee-for-service claims within 365 days from the date of service. Corrections and adjustments must also fall within that window. ACOs set their own limits in their provider contracts.
Which ACOs serve Utah Medicaid members?
Utah Medicaid's ACOs are Health Choice Utah, Healthy U, Molina Healthcare of Utah and Select Health Community Care. Plan availability depends on the member's county, so check eligibility before each visit.
Who is the Medicare contractor for Utah?
Noridian Healthcare Solutions is the Medicare A/B MAC for Utah under Jurisdiction F. Part B claims, appeals and enrollment changes go through Noridian.
Can SFA Solutions work in our Utah EHR?
Yes. We work inside your existing EHR or practice management system, including athenahealth, eClinicalWorks, NextGen, AdvancedMD and many others. We can typically begin within 24 hours of receiving system access.
Get a free billing audit for your Utah practice
We will review your recent claims and denials against Utah payer rules and show you what can be recovered.
Nearby states
Primary sources
- Utah Medicaid ACO MCPAR SFY2025
- Utah Medicaid 2025 Claims and Billing Training
- Utah Code Section 31A-26-301.6
- AANP Utah state practice fact sheet
- CMS: A/B MAC Jurisdiction F (Noridian)
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
Request your free practice audit
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