MedStats Billing delivers end-to-end revenue cycle management built for Utah practices. We hold insurers to the 30-day decision rule and the 20-day payment rule in Utah Code § 31A-26-301.6, answer information requests inside the provider’s own 30-day window so no late fee attaches to you, manage no-fault claims against a $3,000 PIP limit, and bill every Medicaid accountable care organization.
Utah runs its claim rules in both directions. The insurer has 30 days to pay, deny or properly request information, and where it asks for records the provider has its own 30-day clock to answer — and a late fee applies to whichever party is late. Utah is also a no-fault auto state with only $3,000 of required PIP medical coverage, so that benefit is exhausted by a single imaging study and a short course of therapy. Getting paid in Utah is a matter of answering faster than the payer and knowing which coverage is left.
Utah Billing Specializations:
Health Care Claims Practices (Utah Code § 31A-26-301.6) — An insurer must timely pay every valid claim submitted by a provider, and within 30 days of receiving a written claim must pay it, deny it with a written explanation, or request the additional information it needs. Third-party administrators subject to the title are included in the definition of insurer.
Strict Limits on Extensions — The 30-day period may be extended by 30 days only where the insurer determines the extension is necessary due to matters beyond its control and, before the first 30 days expire, notifies the provider and the insured in writing of the circumstances and the date it expects to pay or deny. An extension asserted after the fact does not meet the statute.
Information Requests Must Be Specific — Where the extension is needed because information is missing, the notice must specifically describe the required information, and the insurer must allow at least 45 days from receipt of that notice before denying the claim for failure to provide it. A generic records request does not start that clock.
The Provider’s Own 30-Day Clock — A provider must respond to a proper request for additional information within 30 days by supplying what it holds, unless the insurer agrees to an extension or the provider explains in writing that more time, up to a further 30 days, is required. That written explanation is the step practices skip.
The 20-Day Payment Rule After Records — Once the requested information has been received, the insurer must pay all sums it is obligated to pay and provide a written explanation of any denied portion within 20 days. That is the shortest window in the statute and the easiest one to hold a payer to.
Late Fees Run Both Ways — Utah applies a late fee to an insurer that pays late and to a provider that fails to supply claim information on time, calculated by multiplying the amount of the claim by the number of days late and the statutory rate. Documentation discipline is therefore a direct financial control, not just good practice.
Commissioner Examination & Sanctions — The Insurance Commissioner may examine an insurer’s level of compliance with the section and impose sanctions for each violation, and nothing in the section limits a provider’s collection rights under § 31A-26-301.5.
No-Fault PIP at $3,000 — Utah requires only $3,000 in personal injury protection medical benefits. PIP pays first regardless of fault, and that limit is consumed quickly, so the remaining balance and the next payer in line must be identified before treatment continues rather than after the account ages.
Medicaid Accountable Care Organizations — Utah delivers most Medicaid physical health care through accountable care organizations, including Molina Healthcare of Utah, SelectHealth Community Care and University of Utah Health Plans’ Healthy U, with participation and service areas varying by county. Behavioural health and dental benefits run through separate plans.
Workers’ Compensation — Work injury care is priced under the Labor Commission’s medical fee standards, updated periodically, and the injured worker may not be billed for the balance, so reductions have to be resolved with the carrier or the Commission.
Major Utah Payers — SelectHealth, Regence BlueCross BlueShield of Utah, University of Utah Health Plans, Molina, Aetna, Cigna, UnitedHealthcare and the Public Employees Health Program.
Built to bring clarity, control and consistency to your Utah practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Utah providers — from Medicaid provider enrollment and accountable care organization credentialing, through coding, claim scrubbing and submission, to denial resolution, late fee recovery, records response management and workers’ compensation billing.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
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Explore serviceUtah is the one state where a practice can be penalised for its own paperwork, and where the auto benefit runs out almost immediately. These are the four we eliminate:
A provider must respond to a proper request for additional information within 30 days, or obtain the insurer’s agreement to an extension, or explain in writing that up to 30 more days are needed. Utah applies a late fee to a provider that fails to respond on time, so slow records handling costs the practice money directly.
After the requested information has been received, the insurer must pay everything it owes and explain any denied portion within 20 days. Practices restart their own follow-up cycle instead of holding the payer to that window, and the late fee that should attach never gets claimed.
An insurer may extend the 30-day period only for matters beyond its control, and only by notifying the provider and insured in writing before the first 30 days expire, stating the circumstances and the date it expects to pay or deny. Where information is missing, the notice must specifically describe what is required. Extensions asserted after the deadline, or in generic terms, do not comply.
Utah requires only $3,000 in PIP medical benefits, and PIP pays first. An emergency visit with imaging can absorb most of it, so the remaining balance and the next payer must be confirmed during the course of treatment rather than discovered when the claim is denied.
An insurer must timely pay every valid claim, and within 30 days of receiving a written claim must pay it, deny it with a written explanation, or request the additional information needed to decide it. Once that information arrives, the insurer must pay all sums owed and explain any denied portion within 20 days. Third-party administrators subject to the insurance code are covered by the same duties.
Utah is unusual in applying its late fee to either party. An insurer that pays late and a provider that fails to supply requested claim information on time are both exposed, with the fee calculated from the amount of the claim, the number of days late and the statutory rate. The Insurance Commissioner may also examine compliance and impose sanctions for each violation.
Utah is a no-fault auto state requiring only $3,000 in personal injury protection medical benefits, paid first regardless of fault, with liability recovery available once the statutory threshold is met. Work injury care is priced under the Labor Commission’s medical fee standards and the injured worker may not be balance billed, so a reduction has to be resolved with the carrier or taken to the Commission.
Utah delivers most Medicaid physical health care through accountable care organizations, including Molina Healthcare of Utah, SelectHealth Community Care and University of Utah Health Plans’ Healthy U, with participation and service areas varying by county and behavioural health and dental benefits administered separately. Enrollment and plan assignment are verified before each visit.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles Medicaid enrollment, accountable care organization credentialing, 30-day and 20-day clock tracking, records response management, late fee recovery and workers’ compensation billing across Utah, giving practices end-to-end RCM support in a state whose rules cut both ways.
Claims are scrubbed against accountable care organization and commercial carrier edits before submission to drive clean first-pass reimbursement.
Every information request is answered inside the provider’s 30-day window, or extended in writing before it closes, so no late fee ever attaches to the practice.
We track the insurer’s 30-day decision window and the 20-day payment window after records, and pursue the late fee Utah attaches when a payer misses them.
Working knowledge of SelectHealth, Regence BlueCross BlueShield of Utah, University of Utah Health Plans, Molina, Aetna, Cigna, UnitedHealthcare and the Public Employees Health Program.
Whether you practise in Salt Lake City, Provo, Ogden, St. George or Logan, our workflows adjust seamlessly as your group grows across the state.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, check whether the extensions your payers claimed actually met the statute, and confirm no late fees are attaching to your own records responses.
Under Utah Code § 31A-26-301.6 an insurer must, within 30 days of receiving a written claim, either pay it, deny it with a written explanation, or request the additional information necessary to decide it. Once the requested information has been received, the insurer must pay all sums it is obligated to pay and provide a written explanation of any denied part of the claim within 20 days. Third-party administrators subject to the insurance code carry the same duties.
Only where the insurer determines the extension is necessary due to matters beyond its control and, before the end of the initial 30-day period, notifies the provider and the insured in writing of the circumstances requiring the extension and the date by which it expects to pay or deny the claim. Where the extension is needed because information is missing, the notice must specifically describe the required information, and the insurer must allow at least 45 days from receipt of that notice before denying the claim for failure to provide it.
Yes, and this is the provision practices overlook. Utah applies its late fee both to an insurer that pays a claim late and to a provider that fails to timely provide claim information, with the fee calculated from the total amount of the claim, the number of days the response or payment is late, and the statutory rate. A practice that sits on a records request is exposed in the same way the payer is.
Thirty days from receiving the insurer’s request, supplying the requested information in the provider’s possession, unless the provider has requested and received the insurer’s permission to extend that period, or has explained to the insurer in writing that additional time is necessary, which may not exceed a further 30 days. That written explanation is what protects the practice from a late fee, and it has to be sent before the 30 days run out.
Utah is a no-fault state requiring only $3,000 in personal injury protection medical benefits. PIP pays first regardless of fault, and general damages against the at-fault driver are available only where the statutory threshold is met. Because $3,000 is consumed quickly by emergency care, imaging and a short course of therapy, the remaining benefit and the next payer in line should be confirmed while treatment is ongoing.
Most Medicaid physical health care is delivered through accountable care organizations, including Molina Healthcare of Utah, SelectHealth Community Care and University of Utah Health Plans’ Healthy U, with participation and service areas varying by county. Behavioural health is administered through separate plans and dental benefits through separate contractors, so the correct entity for each service line is confirmed before billing.
We serve practices and healthcare facilities statewide, including Salt Lake City, West Valley City, Provo, West Jordan, Orem, Sandy, Ogden, St. George, Layton, Lehi, Logan, Millcreek, Draper and Park City.
