Expert Revenue Cycle Management in Utah
Mediknocx runs the full revenue cycle for Utah practices, built around the payers that decide your collections here. Select Health carried about 69% of Utah's fully insured medical premium in 2023, and Utah Medicaid splits its members across four ACOs, county mental health plans, and fee-for-service. We handle eligibility, coding, claims, posting, denials, and AR so your staff can stay with patients.
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Your data stays secure
Faster Payments & Fewer Denials
Improve cash flow
Higher Reimbursement
Get the revenue you deserve
Utah Billing Compliance Experts
State-specific payer knowledge
Get Your Free Revenue Assessment
Find out how much revenue your practice could be recovering with expert revenue cycle management support. No obligation, just real insights.
Expert Revenue Cycle Management in Utah: Four Medicaid ACOs, One PRISM Portal, and a Behavioral Health Carve-Out
Utah Medicaid does not route every claim to one place. The Division of Integrated Healthcare contracts with four Accountable Care Organizations (Health Choice Utah, Healthy U, Molina Healthcare, and Select Health Community Care), and most members in 13 counties, including Salt Lake, Utah, Davis, and Weber, must enroll in one. Mental health and substance use services go to county-based Prepaid Mental Health Plans instead, and most Medicaid expansion members stay in fee-for-service. A single patient's medical and therapy visits can land with three different payers.
Fee-for-service claims run through PRISM, the state's claims and prior authorization system, which accepts only electronic claims or direct data entry. PRISM denies claims billed without a matching prior authorization, and a member's eligibility or ACO assignment can change month to month. That makes eligibility checks before every visit a core part of Utah revenue cycle work, not an afterthought.
Expertise
Built for local care models
Deadline Tracking
We flag at-risk claims early
Fewer Denials
Correct coding, less revenue loss
The Full Revenue Cycle We Manage in Utah
- Patient Access & Eligibility Verification: Medicaid eligibility and ACO checks through the state Eligibility Lookup Tool or 270/271 transactions, plus commercial benefit checks before the visit.
- Charge Capture & Coding: CPT, ICD-10-CM, and HCPCS coding reviewed against NCCI edits, which the Utah Medicaid provider agreement requires providers to follow.
- Claims Submission: Clean electronic claims sent to the right payer, whether that is an ACO, a Prepaid Mental Health Plan, fee-for-service Medicaid in PRISM, or a commercial plan.
- Payment Posting: ERA and EOB posting with underpayment checks against your contracted rates.
- Denial Management & Appeals: Managed care appeals filed within the 60-day window after an adverse benefit determination, with state fair hearing requests tracked when a plan upholds a denial.
- AR Follow-Up: Aged claims worked by payer, with Utah's 30-day commercial payment rule used to flag late payers early.
- Reporting: Monthly reports on collections, denial trends, and days in AR.
How It Works
From Audit toFaster Payments in 4 Steps
A simple, proven process to streamline your revenue cycle and maximize reimbursements in Utah.
Free Audit
We review your Utah claims, denials, and aging AR to find where revenue is slipping.
Custom Plan
You get a written plan matched to your payer mix, specialty, and staffing.
Seamless Transition
We connect to your EHR and clearinghouse and take over billing without pausing claim flow.
Ongoing Reporting
Monthly reports show what was billed, collected, denied, and recovered.
Get Your FreeRevenue Cycle Audit Report
Wondering how much your Utah claims are leaving on the table? Call +1 434-201-9720 or email info@mediknocx.com to schedule a free revenue cycle audit.
What Makes Our Utah
Revenue Cycle Management Different
Utah practices need an RCM partner that knows a market shaped by one dominant commercial payer and a Medicaid program split across several plans.
Full-Cycle Ownership
One team manages your cycle from eligibility check to final payment, so a coding problem spotted during denial review gets fixed at the source instead of repeating on next month's claims.
Select Health Payer Focus
Select Health carried about 69% of Utah's fully insured medical premium in 2023. We watch its claim edits, authorization rules, and payment timing closely because they shape most commercial revenue here.
Timely Filing Tracking
Every claim is logged against its payer's filing window, including 365 days for Healthy U Medicaid, so rejected or stalled claims get corrected and resubmitted before that window closes on you.
Monthly Reporting Cadence
Each month you receive a plain report on collections, denial rates by payer, and AR aging, with notes explaining what changed since last month and what we are doing about it.
Compliance Built Into Workflow
Coding follows NCCI edits and Utah Medicaid documentation rules, and patient statements follow Utah's collection timing limits, which lowers audit exposure without slowing your claims down.
Specialty Depth
Our coders work across 47 specialties, so a Provo pediatric group and a Salt Lake City cardiology practice each get billers who know their code sets and payer rules.
Revenue Cycle Support for 47 Medical Specialties in Utah
Mediknocx supports 47 medical specialties, including family practice, internal medicine, pediatrics, OB-GYN, cardiology, orthopedics, behavioral health, and urgent care. Specialty knowledge matters most at the coding and denial stages, where a missed modifier or unsupported diagnosis turns into lost revenue.
How Does Mediknocx Ensure Compliance
With Utah Medical Billing Regulations?
No Surprises Act
We apply federal good faith estimate rules for uninsured and self-pay patients and the balance billing protections that cover emergency care and certain out-of-network services.
Utah Timely Payment Law
Utah Code 31A-26-301.6 requires insurers to pay or deny a provider's claim within 30 days of receipt unless they send a written extension notice. We track that clock on every commercial claim and escalate when it runs out.
Utah Billing Transparency
Under Utah Code 31A-26-301.5, a provider cannot report a patient to a credit bureau or use a collection agency until the insurer's decision window has passed. We hold patient balances until that point.
Payer-Specific Guidelines
We follow the published provider manuals for Select Health, Regence BlueCross BlueShield of Utah, University of Utah Health Plans, and each Utah Medicaid ACO.
Healthcare Billing Services Across Utah Cities
We support practices in Salt Lake City, Provo, and Ogden, where most of Utah's physician groups and specialty clinics sit along the Wasatch Front and bill a mix of Select Health, Regence, and Medicaid ACO patients.
- Salt Lake City
- West Valley City
- West Jordan
- Provo
- St. George
Serving Healthcare Providers Nationwide
Beyond Utah, Mediknocx supports practices in Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, Idaho, Hawaii, Georgia, and Delaware.
Let's get your Utah revenue cycle working the way it should. Talk to a Mediknocx RCM specialist at +1 434-201-9720 or info@mediknocx.com and we'll show you where the fastest gains are.
Frequently Asked Questions
Find answers to the most common questions about our revenue cycle management services in Utah.
