Utah Prior Authorization Rules and Response Timeline

Utah SB 62 (2022) establishes some of the fastest prior authorization timelines in the nation. Standard requests must be decided within 3 business days, and urgent requests within just 1 business day.

Utah SB 62 (2022) Response Timelines

Utah SB 62, enacted in 2022, requires insurers to respond to prior authorization requests within tight timeframes: standard requests within 3 business days of receipt, and urgent requests within 1 business day of receipt. These are among the fastest timelines in the nation.

Emergency Services Exception

Emergency services are exempt from prior authorization requirements. Insurers cannot require preapproval for emergency care, but may conduct retrospective review of emergency claims within 30 days of service.

Denial Notice Requirements

When an insurer denies a prior authorization request, the denial must include the specific clinical criteria used in the decision and the evidence-based rationale supporting the denial. Vague denials lacking clinical justification are insufficient.

Internal Appeal and Urgent Appeal Timelines

Patients and providers have 180 days from the denial date to file an internal appeal with the health plan. For urgent requests, an expedited appeal must be filed and decided within 1 business day. If the internal appeal is denied, the Utah Insurance Department provides external review.

How to Appeal a Denied PA in Utah

1. Obtain the PA denial with specific clinical criteria cited in the decision.
2. Prepare clinical documentation addressing each stated criterion in the denial.
3. File an internal appeal within 180 days of denial (1 business day for urgent requests).
4. Request UID external review if the internal appeal is denied.

Frequently Asked Questions

Related Utah Insurance Topics

• Utah Timely Filing Requirements
• Utah Balance Billing Protections
• Utah Surprise Billing Protections
• All State Billing Laws
• Federal Prior Authorization Guidelines