University Of Utah Health Plan Claims Submitting Guidelines

University Of Utah Health Plan ClaimsUniversity Of Utah Health Plan Claims Submitting supposes several different options through UHIN. These include the following:

  • Direct link – Provider is creating a HIPPA compliant file from their billing system and is sending the file to the UHIN HIPPA server (UHINet).
  • ProClaim – A Regence dial-up product, ProClaim is free to UHIN members.
  • UHINT – An internet-based product, UHINT is free to UHIN members.
  • uTRANSEND – Clearinghouse services
  • Other clearinghouses – Several billing systems have created a connection to UHIN payers through a clearinghouse. There clearinghouses, in turn, connect to UHINet.

University Of Utah Health Plan Claims Submitting Contracted Clearinghouses

A partial list of UHIN contracted clearinghouses appears below:

  • Relay Health/McKesson =
    • Payer ID #4779 (professional claims)
    • Payer ID # 5920 (institutional claims)
  • WebMD/Emdeon = payer ID # SX155
  • Caprio = Payer ID # SX155
  • Gateway EDI= Payer ID # 00179
  • Navicur =
    • Payer ID # 4779 (professional claims )
    • Payer ID # 5920 (institutional claims)
  • Apex EDI = Payer ID # UHUOU
  • Ingenix = Payer ID # SX155
  • SSI Group: SX155
  • Zirmed: Z1030
  • Practice Insight: SX155
  • Med USA: HT000179-002
  • Office Ally: SX155
  • ENS Clearinghouse: SX155

Payer ID numbers are assigned by the clearinghouse. As University of Utah Health Plans does not assign or maintain these numbers, please contact your clearinghouse for this information.

Paper Claims

There may be instances when you need to submit your claims on paper. UUHP has no plans at this time to require providers to submit claims electronically. However, UUHP would prefer that providers submit claims electronically, so if you need assistance on how to send EDI claims please contact University Of Utah Health Plan.

University Of Utah Health Plan Claims Submitting Tips


The 5010 837 transaction allows for providers to submit a claim electronically while submitting attachments on paper.  Elements in the file will indicate if you are sending an attachment, the type of attachment you are sending, and identification number for the attachment and the mode for sending the attachment (fax, email, etc.).

University Of Utah Health Plan feels this is a valuable tool and would ask that providers who submit an electronic claim and also submit a paper attachment for that claim to use these fields.  When sending UUHP an attachment, please verify that the identification number that was provided in the electronic file is also on the attachment so we can identify the claim that the attachment belongs to. University Of Utah Health Plan will pend all claims that you have indicated have an attachment until UUHP have received that attachment.

Corrected Claims

UUHP can accept corrected claims by EDI and UUHP prefers to receive claims by EDI. There are two ways a provider may submit a corrected claim.

  1. Claim Header Level: Place a code 7 in the CLM05-3 segment (see 5010 Implementation Guides on Claim Frequency Type Code, page 161)
  2. Service Line Level: Place a CC modifier on the service line.

Only one method is required to submit a corrected claim, UUHP does not need to have both codes sent on a claim.


Claim notes, claim line notes (professional claims only), and claim billing notes (institutional claims only) can be submitted in the electronic file. UUHP will not know if the claim note(s) affect the claim payment, therefore UUHP will pend any claims with claim notes for review. If the notes you are submitting do not affect claim payment the claims will take longer to process as they will require manual review, so we ask that you limit claim notes to only information such as:

  • Accident details
  • Auto or subrogation detail
  • Any special circumstances.

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