Medical Billing Services in Utah

Utah looks straightforward on the surface. It is not. The state runs Medicaid through multiple managed care plans. These are SelectHealth Community Care, Molina Healthcare, Healthy U, and Health Choice. Each has separate authorization processes, claim portals, and documentation requirements. On top of that, Utah does not publish a master fee schedule. Providers have to check reimbursement rates code by code through the state’s online lookup tool. And 2026 brought more changes, like a Hybrid Unified Preferred Drug List that took effect in January. That aligns drug coverage between fee-for-service and managed care for the first time. Practices that did not adjust their billing processes are already seeing problems.

Providers Care Billing LLC delivers medical billing services in Utah built around what the state actually requires right now, not what it required two years ago.

Billing Fees Starting at 2.49%

How We Manage Your Revenue Cycle in Utah

As a committed medical billing company in Utah, we cover every stage of your billing from patient registration to final payment. Our Utah medical billing & coding services are structured around Utah’s managed care rules, Medicaid requirements, and commercial payer standards so your practice stays paid and stays compliant.

Insurance Verification & Managed Care Plan Identification

Utah Medicaid members are enrolled across four different managed care plans. We confirm which plan covers each patient, verify active eligibility, check benefit limits, and identify prior authorization requirements before the visit. This step alone eliminates a significant portion of preventable denials.

Medical Coding

Our certified coders apply ICD-10, CPT, and HCPCS codes correctly on every claim. They stay current on Utah Medicaid policy updates, SelectHealth Community Care coding requirements, and commercial payer documentation standards specific to Utah. Accurate coding from the start means fewer rejections and fewer audit risks.

Utah Medicaid Fee Schedule Monitoring

Utah does not publish a downloadable master fee schedule. Reimbursement rates are checked code by code through the state’s online lookup tool and vary between fee-for-service and managed care contracts. We monitor fee schedule updates, track underpayments against contracted rates, and flag discrepancies before they become accepted loss

Hybrid PDL Billing Compliance

Utah’s Hybrid Unified Preferred Drug List took effect in January 2026. It aligns drug coverage between fee-for-service Medicaid and MCO plans. Practices billing pharmacy-adjacent services need to submit under the unified formulary now. We track these changes and apply them before they cause denials.

ABA Therapy Billing

Utah boosted ABA therapy reimbursement rates in 2025. Billing for ABA under Utah Medicaid requires specific coding, documentation, and authorization steps. We handle ABA claims correctly so your practice captures the full updated rate on every session billed.

Credentialing & Enrollment

We manage enrollment with SelectHealth Community Care, Molina Healthcare, Healthy U, Health Choice, Regence BlueCross BlueShield of Utah, PEHP, UnitedHealthcare, and Medicare so your providers stay active across every Utah payer network.

Charge Capture

Every service gets documented and entered without gaps. No billable item gets missed. Your practice collects for everything it delivers.

Claim Submission

Every claim is reviewed before it goes out — coding, documentation, payer formatting. Clean claims go to the right payer through the right channel and come back paid.

Prior Authorization

Utah payers require upfront approval for a wide range of procedures. We manage documentation, submission, payer follow-up, and retro authorization for emergencies. Approvals are secured before services happen.

AR Management

Every open claim gets followed up on within seven days. We push for resolution, escalate delays with payers directly, and keep your accounts receivable from aging.

Denial Recovery

Every denial gets worked and appealed. We also identify patterns across your account and fix recurring issues at the source not claim by claim, indefinitely.

Get Our Full Range of Medical Billing Services in Idaho

Here is Why 2000+ Providers Trust Us!

At Providers Care Billing LLC, we go beyond traditional medical billing. Our expert Revenue Cycle Management solutions are built to increase collections, minimize claim denials, and keep your practice running efficiently so you can focus on delivering exceptional patient care.

Why Utah Providers Choose Providers Care Billing LLC

Utah billing is not one-size-fits-all. Four separate Medicaid managed care plans. No publicly downloadable fee schedule. Policy updates that roll out mid-year without much notice. Most billing companies handle Utah the same way they handle every other state and Utah practices end up paying for that with denied claims and delayed revenue. Providers Care Billing LLC is built differently.

We Know Utah's Four Medicaid Plans

Our Utah medical billers and coders work daily with SelectHealth Community Care, Molina Healthcare, Healthy U, and Health Choice. Each plan has different authorization rules, different claim portals, and different processing timelines. We build every Medicaid claim around the specific plan covering that patient.

We Stay Ahead of Utah Policy Changes

The Hybrid PDL changed in January 2026. ABA rates changed in 2025. Utah’s rural physician bonus is under review for April 2026. Most billing companies find out about these changes after the denials start. We track every Utah DHHS update and adjust our billing processes before the changes affect your reimbursements.

Reporting That Makes Sense

Monthly reports show your collection rate by payer, denial reasons, AR aging, and turnaround times. Utah practices with multiple Medicaid plans need to see exactly where revenue is moving and where it is not.

Fees starting at 2.49% of Collections

We charge 2.49% of collected revenue. No contracts. No setup fees. You pay when your practice collects.

One Account Manager for Your Practice

One person handles your account. They know your specialty, your payer mix, and your billing history. One contact, full accountability, no call queues.

Get Our Full Range of Medical Billing Services in Utah

Simplifying Medical Billing for Healthcare Providers Across Utah

Providers Care Billing LLC helps Utah healthcare providers reduce claim denials, improve cash flow, and maximize reimbursements with end-to-end medical billing services.

Medical Billing & Coding Specialties in Utah

Providers Care Billing LLC handles medical billing specialties in Utah across every major clinical discipline. From primary care and pediatrics to behavioral health, ABA therapy, surgical specialties, and long-term care. Our expert medical billers in Utah apply specialty-specific knowledge and Utah-specific payer rules to every claim. The full list of specialties we cover is below.

Primary Care

Urgent Care

Geriatrics

Psychiatry

Psychology

Therapy & Counseling

Abuse Treatment

ABA Therapy

OB/GYN

Fertility Clinics

Urology

Men’s Health

Pediatrics

Pediatric Subspecialties

Cardiology

Keeping Billing In-House in Utah Is Getting Harder

Utah’s billing environment changed significantly in 2025 and 2026. New drug formulary rules. Updated ABA rates. Managed care credentialing requirements across four separate Medicaid plans. Rural reimbursement changes are pending. In-house billing teams that are not actively tracking these updates are submitting under old rules and losing money without knowing why. When you outsource medical billing and coding in Utah to Providers Care Billing LLC, that stops. You get a team already current on every Utah policy change, working your revenue cycle every day. As one of the best medical billing companies in Utah, we take the complexity off your plate completely so your team can stay focused on patient care.

Providers Care Billing LLC Across the USA

We deliver the same accuracy and accountability to healthcare providers across the United States. Explore our state pages to see how we work with practices in your area.

testimonials

Discover What Our Clients Say About Us

With a dedicated biller and manager matched to your practice specialty, your clinic benefits from expert billing guidance, consistent oversight, and HIPAA-compliant processes, allowing you to focus on delivering exceptional patient care while maximizing revenue.

“

I have been using Providers Care Billing for 4 months now and my only regret is that I didn't do it sooner. Gustavo and his team have been so incredibly helpful and they are thorough and professional. Because of them, my time has been freed up to concentrate on other aspects of my practice, like supervision and patient care. They are worth every penny. I highly recommend.

Jill Harmon, LCSW, PC

Mindfulness Matters Psychotherapy

Google Rating ⭐⭐⭐⭐⭐

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I have utilized Providers Care Billing's credentialing services several times now for my group practice and I am continuing impressed with their response times and clear communication. Prior to working with them, I had worked with other credentialing services who did not provide quality services (lack of communication, incomplete applications, and delays). A fresh approach to credentialing.

Julia Hogan-Werner, LCPC

Vita Optimum Counseling

Google Rating ⭐⭐⭐⭐⭐

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Providers Care Billing has truly been a lifesaver. As a growing practice, they have been able to not only help with billing and credentialing but have been able to provide guidance with the different insurance providers and their procedures. In addition, the customer service and response time received have been extremely helpful in understanding how valuable it is to have a trusted service that is dependable...

N'Perfect Balance

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

“

I can't say enough good things about this company. We were losing money monthly with our old billing company. Now our A/R is where it should be! They are easily accessible and every question has been answered thoroughly.Thank you Gustavo and Provider Care Billing.They answer our clients' questions directly. They go after every claim aggressively. They are amazing!

Dr. Vincent Meoli

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

“

Great team to work with Provides timely service I highly recommend

Dr. Venkata Buddharaju

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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Providers Care Billing has been amazing for my private practice needs over the past year. Gustavo and his team are attentive, quickly responsive and professional in every way. I highly recommend using their services!

Andy Huys

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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I love receiving help with insurance billing and collection from PCB. They are a VERY responsive and efficient operation. No waiting for an answer, ever. Their modest fee structure feels like one of the most efficient costs in my practice.

Reid Stell

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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We started our practice almost a year ago and have been using Providers Care Billing since the beginning. They have been amazing! They respond to our questions in a very timely manner and have supported us in resolving any issue we have had with insurance companies. The rate we pay for this service can't be beat. We highly recommend Providers Care Billing LLC.

Katie Kussard

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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Everything about Providers Care is five stars. Their rates are reasonable. You will not find better customer service. I'm a therapist, and not an expert on working with insurance companies. Thanks to Providers Care. Honestly, the amount of money I spend with them is probably less than the amount I was losing from claims that did not go through. You will be more than satisfied with their service!

Jason Rohman

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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I would highly recommend Providers Care Billing LLC to any practice looking for a medical billing company. Providers Care Billing LLC is very knowledgeable, quick and efficient with any problems or questions we have had. They have helped our office tremendously.

Danielle Shuman

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

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Very responsive, easy to work with, claims filed very fast. Affordable. A completely different experience.

Dr. Aleksandra Giedwoyn, MD

Happy Customer

Google Rating ⭐⭐⭐⭐⭐

FAQs

Frequently Asked Questions

Find quick answers to the most common questions about our services, features, and how we can support your business. If you need more details, our team is always here to help.

Why does Utah Medicaid billing feel more complicated than in other states?

Utah runs Medicaid through four separate managed care plans. Each has different authorization portals, documentation requirements, and claim timelines. There is no single master fee schedule either. Reimbursement rates have to be checked code by code through the state’s online lookup tool. Getting all of this right takes billing experience specific to Utah.

What is SelectHealth Community Care and how does it affect provider billing?

SelectHealth Community Care is Utah’s largest Medicaid managed care plan. Providers billing SelectHealth members must be enrolled under either formal or limited enrollment with Utah Medicaid and submit claims through SelectHealth’s specific portal. Billing requirements differ from fee-for-service Medicaid billing.

What changed with Utah Medicaid in January 2026?

Utah launched a Hybrid Unified Preferred Drug List in January 2026. It aligns drug coverage between fee-for-service Medicaid and all managed care plans. Providers billing pharmacy-adjacent services now follow one unified formulary across both billing tracks — a change that required immediate updates to billing workflows.

Does Providers Care Billing LLC handle ABA therapy billing in Utah?

Yes. Utah increased ABA therapy reimbursement rates in 2025. ABA billing under Utah Medicaid requires specific CPT codes, detailed session documentation, and prior authorization. We handle all of it correctly so your practice captures the full updated rate on every claim.

What is PEHP and do you manage billing for it?

PEHP is the Public Employees Health Program. Utah’s health plan for state and public school employees. It is one of Utah’s significant commercial payers and has its own billing requirements. We manage PEHP claims alongside all other Utah commercial and Medicaid billing.

How quickly can a Utah practice get started with Providers Care Billing LLC?

Most practices are fully onboarded and submitting claims within 2 to 3 business days with no disruption to daily operations during the transition.

What makes Providers Care Billing LLC better than other medical billing companies in Utah?

We know Utah’s four Medicaid plans, track state policy changes before they affect claims, and give every practice one dedicated account manager who is personally responsible for results. Our billing fees start at 2.49% and our clean claims rate stays above 98%.

Utah Practices Deserve Billing That Keeps Up With the State

Utah’s payer rules change. Medicaid plans update their requirements. Reimbursement schedules shift. Providers Care Billing LLC stays current on all of it so your practice does not take the hit every time something changes. From the first eligibility check to the last payment posted, we handle your complete revenue cycle so nothing falls through.

Contact us today and find out what your Utah practice should actually be collecting.

Medical Billing Services in Utah

Billing Fees Starting at 2.49%

How We Manage Your Revenue Cycle in Utah

Insurance Verification & Managed Care Plan Identification

Medical Coding

Utah Medicaid Fee Schedule Monitoring

Hybrid PDL Billing Compliance

ABA Therapy Billing

Credentialing & Enrollment

Charge Capture

Claim Submission

Prior Authorization

AR Management

Denial Recovery

Get Our Full Range of Medical Billing Services in Idaho

Here is Why 2000+ Providers Trust Us!

98.71%

98.25%

99%

97%

99%

15-30%

Why Utah Providers Choose Providers Care Billing LLC

We Know Utah's Four Medicaid Plans

We Stay Ahead of Utah Policy Changes

Reporting That Makes Sense

Fees starting at 2.49% of Collections

One Account Manager for Your Practice

Get Our Full Range of Medical Billing Services in Utah

Simplifying Medical Billing for Healthcare Providers Across Utah

Medical Billing & Coding Specialties in Utah

Primary Care

Urgent Care

Geriatrics

Psychiatry

Psychology

Therapy & Counseling

Abuse Treatment

ABA Therapy

OB/GYN

Fertility Clinics

Urology

Men’s Health

Pediatrics

Pediatric Subspecialties

Cardiology

Keeping Billing In-House in Utah Is Getting Harder

Providers Care Billing LLC Across the USA

Discover What Our Clients Say About Us

With a dedicated biller and manager matched to your practice specialty, your clinic benefits from expert billing guidance, consistent oversight, and HIPAA-compliant processes, allowing you to focus on delivering exceptional patient care while maximizing revenue.

Jill Harmon, LCSW, PC

Julia Hogan-Werner, LCPC

N'Perfect Balance

Dr. Vincent Meoli

Dr. Venkata Buddharaju

Andy Huys

Reid Stell

Katie Kussard

Jason Rohman

Danielle Shuman

Dr. Aleksandra Giedwoyn, MD

Frequently Asked Questions

Utah Practices Deserve Billing That Keeps Up With the State

Head Office

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