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Intermountain Health operates the dominant hospital network across Utah, and its insurance arm, SelectHealth, controls leading commercial, Medicaid ACO, and Medicare Advantage volume. Independent practices must understand SelectHealth’s proprietary clinical criteria, pre-authorization portals, and network tiering to avoid steerage and denials.
Utah Medicaid delivers care through four contracted ACOs: SelectHealth Community Care, University of Utah Health Plans, Molina Healthcare of Utah, and Health Choice Utah. Providers must maintain active panel credentials with each ACO and adhere to mandatory referral authorization loops.
Medicare Part A and Part B claims across Utah are processed by Noridian Jurisdiction F. Noridian actively enforces Local Coverage Determinations (LCDs) on minor surgical interventions, physical therapy caps, diagnostic imaging, and evaluation and management coding.
Under Utah law, insurers must pay clean electronic claims within 30 days. Claims unpaid within this statutory window accrue interest penalties payable directly to the healthcare provider. We track clearinghouse timestamps to enforce statutory payment compliance.
Full-service billing and coding tuned specifically for SelectHealth (Intermountain Health) / Regence BCBS contracts and Noridian (Jurisdiction F) Medicare coverage policies.
Learn MoreEnd-to-end RCM that tracks Utah payer pre-authorization turnaround, secondary crossovers, and fee schedule compliance.
Learn MoreProvider enrollment and roster alignment across Utah Medicaid programs, commercial networks, and hospital health systems.
Learn MoreTargeted historical audit analyzing 90 days of claims for Utah underpayments, modifier misalignments, and prompt pay interest.
Learn MoreFront-desk patient intake, real-time insurance verification, and prior authorization handling without local staffing overhead.
Learn MoreReal-time performance analytics benchmarking your collection velocity against Utah specialty peer averages.
Learn MoreHigh-intent patient acquisition for independent medical practices competing with consolidated hospital networks in Utah.
Learn More| Utah Payer Reality | The Generic Billing Trap | The MD Revenue Group Approach |
|---|---|---|
| SelectHealth Integrated Delivery | Treating SelectHealth like a standard commercial HMO, missing proprietary clinical protocols and preferred panels. | We manage direct SelectHealth portal authorizations and verify allowable reimbursement schedules. |
| Utah Medicaid 4 ACOs | Submitting claims to the wrong ACO or neglecting ACO-specific referral authorization loops. | We synchronize provider rosters across SelectHealth Community Care, UUHP, Molina, and Health Choice. |
| Noridian JF Medicare Governance | Submitting complex E/M visits or minor procedures without documenting medical decision-making complexity. | We audit clinical documentation against Noridian JF Local Coverage Determinations before claim generation. |
| Utah Code Ann. § 31A-26-301.6 | Allowing commercial insurers to delay clean claim settlement past 30 days without requesting interest penalties. | We log clearinghouse submission records and enforce statutory interest penalties on overdue claims. |
We analyze 90 days of recent claims data to uncover SelectHealth contract shortfalls and Noridian modifier mismatches.
Targeted workflow fixes to address local prior authorization delays, Medicaid hurdles, and timely filing bottlenecks.
We establish seamless clearinghouse connections with Noridian, Medicaid, and commercial plans while your practice continues billing uninterrupted.
Transparent tracking toward 98%+ first-pass clean claim rate, under 32 average days in A/R, and maximized provider revenue.
Our Utah team untangled SelectHealth prior authorization bottlenecks, updated University of Utah Health Plan rosters, and shortened A/R from 46 to 27 days.
See What We Can Recover For YouUtah DHHS continues integrating physical and behavioral health reimbursement under ACO contracts, requiring standardized screening and collaborative care coding.
Noridian is auditing claims billing joint injections, trigger point therapy, and minor skin excisions for medical necessity documentation compliance.
We audit specifically for SelectHealth (Intermountain Health) / Regence BCBS fee shortfalls, Utah Medicaid ACOs (SelectHealth, U of U, Molina, Health Choice) credentialing holdbacks, and Noridian (Jurisdiction F) Local Coverage Determinations.
