Utah Code Title 26B. Utah Health and Human Services Codes § 26B-3-1004. Health insurance entity--Duties related to state claims for Medicaid payment or recovery

(a) with respect to an individual who is eligible for, or is provided, medical assistance under the state plan, upon the request of the department, provide information to determine:

(b) accept the state's right of recovery and the assignment to the state of any right of an individual to payment from a party for an item or service for which payment has been made under the state plan;

(c) respond within 60 days to any inquiry by the department regarding a claim for payment for any health care item or service that is submitted no later than three years after the day on which the health care item or service is provided;

(d) not deny a claim submitted by the department solely on the basis of the date of submission of the claim, the type or format of the claim form, or failure to present proper documentation at the point-of-sale that is the basis for the claim, if:

(e) not deny a claim submitted by the department or the department's contractor for an item or service solely on the basis that such item or service did not receive prior authorization under the third-party payer's rules.

(a) construe and implement Subsection (1)(e); and

(b) encourage health care providers to seek prior authorization when necessary from a health insurance entity that is the primary payer before seeking third-party liability through Medicaid.