Hearings

Hearings Unit

When a Medicaid member, provider, or other interested party is dissatisfied with an action taken by Utah Medicaid, a hearing may be requested by filing a hearing request with the Hearings Unit to appeal the action. A denial of eligibility for Medicaid, Children's Health Insurance Program (CHIP), or Primary Care Network (PCN) must be filed with the Division of Workforce Services.

Most Medicaid denials are communicated by letter or fax, and contain information about filing an appeal, including the time within which an appeal must be filed. When a provider wishes to appeal a payment reflected by an explanation of benefits, or other remittance document issued by Medicaid, a hearing request must be filed within 30 calendar days of the date of the remittance document.

A member or provider wishing to dispute an action taken by an Accountable Care Organization or Managed Care Organization must complete the appeal process within that organization before filing a hearing request with the Hearings Unit.

Additional information is contained in the Utah Medicaid Provider Manual, General Information - Section I, Chapter 6-15.

Mailing Address:

DIVISION OF MEDICAID AND HEALTH FINANCING
DIRECTOR'S OFFICE/HEARINGS UNIT
BOX 143105
SALT LAKE CITY, UT 84114-3105

Street Address:

DIVISION OF MEDICAID AND HEALTH FINANCING
DIRECTOR'S OFFICE/HEARINGS UNIT
288 NORTH 1460 WEST
SALT LAKE CITY, UT 84114-3105

Fax: (801) 536-0143

Hearing Request Form in English and Spanish

Laws and Rules:
42 Code of Federal Regulations Part 431, Subpart E
42 Code of Federal Regulations Part 438, Subpart F
Utah Administrative Procedures Act: Utah Code Annotated, Title 63G, Chapter 4
Utah Administrative Code, Title R410: Administrative Hearing Procedures