Medical Billing Services in Utah

Utah’s Medicaid system has its own vocabulary, and billing it correctly starts with learning it. The state delivers most Medicaid through Accountable Care Organizations, and whether a member must enroll in one depends on the county they live in. Get the county, the plan, and the carve-outs right, and Utah claims move cleanly. Miss any of the three, and the same encounter comes back denied.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Utah practices of every specialty, built around the state’s actual payers and programs.

Utah’s payer landscape

Utah Medicaid delivers most services through four Accountable Care Organizations, or ACOs: Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care. Enrollment in an ACO is mandatory for most Medicaid members living in 13 counties, including Salt Lake, Utah, Davis, Weber, Cache, and Washington counties. In other counties, ACO enrollment is voluntary and members may use the fee-for-service network instead. Not every ACO is available in every county, so county and plan must both be verified before the visit.
Two carve-outs matter for billing. Behavioral health and dental services are not covered by the ACOs and follow separate paths, so a claim routed to the ACO for a carved-out service will not pay.
Commercial coverage is led by SelectHealth, alongside Regence BlueCross BlueShield of Utah, UnitedHealthcare, Cigna, and University of Utah Health Plans. Medicare and Medicare Advantage plans add their own prior authorization rules on top of the Medicaid and commercial mix.

What MedPlus RCM handles for Utah practices

  • End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
  • Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
  • Provider credentialing and enrollment. End-to-end enrollment with Utah Medicaid ACOs, commercial payers, and Medicare, plus re-credentialing maintenance.
  • Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
  • A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
  • Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
    We serve practices statewide, Salt Lake City, Provo, Ogden, Orem, St. George, and Logan, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.

Results Utah practices can check

MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.

Frequently asked questions

Does every Utah Medicaid member have an ACO?
No. ACO enrollment is mandatory in 13 counties, including Salt Lake, Utah, Davis, Weber, Cache, and Washington. Elsewhere, members may use the fee-for-service network, so county of residence decides the billing path.
Do ACOs cover behavioral health and dental?
No. Behavioral health and dental are carved out of the ACOs and follow separate paths, so those claims must be routed correctly from the start.
Do you work with Utah Medicaid ACOs?
Yes. We bill Health Choice Utah, Healthy U, Molina Healthcare, and SelectHealth Community Care, as well as commercial and Medicare plans.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.

Get a free financial audit

Find out where your Utah practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
Request your free financial audit