Utah Code Title 31A. Insurance Code § 31A-26-301.7. Dental claim transparency

(a) “Bundling” means the practice of combining distinct dental procedures into one procedure for billing purposes.

(b) “Dental plan” means the same as that term is defined in Section 31A-22-646.

(c) “Downcoding” means the adjustment of a claim submitted to a dental plan to a less complex or lower cost procedure code.

(d) “Covered services” means the same as that term is defined in Section 31A-22-646.

(e) “Material change” means a change to:

(a) make a copy of the insurer's current dental plan policies available online; and

(b) if requested by a provider, send a copy of the policies to the provider through mail or electronic mail.

(a) a summary of all material changes made to a dental plan since the policies were last updated;

(b) the downcoding and bundling policies that the insurer reasonably expects to be applied to the dental provider or provider's services as a matter of policy; and

(c) a description of the dental plan's utilization review procedures, including:

(a) based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a dental provider from collecting the fee for the actual service performed from either the plan or the patient; or

(b) uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.