Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in Utah
- An excluded provider can make a written request for a commissioner hearing on whether the exclusion fit the statute's criteria; the commissioner may, but need not, hold one.
- A plan may not reject an applicant solely for privileges at a hospital outside its network or for referral patterns for patients it does not cover.
- The Insurance Department says it has no authority over self-funded employer plans.
Does Utah have an any willing provider law?
A licensed provider willing and able to meet a managed care organization's terms may apply for and receive network designation, but terms may limit the number of providers on objective economic grounds. It covers insurer-licensed plans, not HMOs. An excluded provider may ask the commissioner for a hearing.
- Limited any willing provider law
Citation: Utah Code 31A-45-303(3)(b), (6)(b)-(c)
How long can a plan take to credential a provider in Utah?
A managed care organization must decide on an application within 120 days of receiving it with all necessary information. A rejection must give the reason measured against the plan's filed criteria.
- Deadline: 120 days
- Applies to: Managed care organizations; all provider applicants
Citation: Utah Code 31A-45-304(1)(d)-(e)
Filed criteria for adding providers
Each managed care organization must set criteria for adding providers, which may include how many providers it needs, file them with the Insurance Department, and give them to any provider on request.
Citation: Utah Code 31A-45-304(1)(a)-(c)
Will the Utah insurance department take a provider complaint?
- Utah Insurance Department
Who oversees Medicaid managed care plans in Utah?
- Utah Department of Health and Human Services (Utah Medicaid)
Turned down by a plan in Utah?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not Utah's. A rejection review is $249, credited toward a dispute.