{"data":{"id":"us-ut/utah-code-31a-26-301.7","jurisdiction":"us-ut","citation":"Utah Code § 31A-26-301.7","heading":"Dental claim transparency and practices.","body":"(1) As used in this section:\n(a) \"Bundling\" means the practice of combining distinct dental procedures into one procedure for billing purposes.\n(b) \"Dental plan\" means the same as that term is defined in Section 31A-22-646.\n(c) \"Downcoding\" means the adjustment of a claim submitted to a dental plan to a less complex or lower cost procedure code.\n(d) \"Covered services\" means the same as that term is defined in Section 31A-22-646.\n(e) \"Material change\" means a change to:\n(i) a dental plan's rules, guidelines, policies, or procedures concerning payment for dental services;\n(ii) the general policies of the dental plan that affect a reimbursement paid to providers; or\n(iii) the manner by which a dental plan adjudicates and pays a claim for services.\n(f) \"Procedure code\" means the Current Dental Terminology code maintained by the American Dental Association.\n(g) \"Professionally accepted treatment\" means a dental service, medication, material, technology, or procedure that meets generally accepted practice standards to complete a procedure code.\n(h) \"Unbundling\" means the systematic separate billing of distinct dental procedures by a dental provider that results in transparent documentation of actual services rendered.\n(2) An insurer that contracts or renews a contract with a dental provider shall:\n(a) make a copy of the insurer's current dental plan policies available online; and\n(b) if requested by a provider, send a copy of the policies to the provider through mail or electronic mail.\n(3) Dental policies described in Subsection (2) shall include:\n(a) a summary of all material changes made to a dental plan since the policies were last updated;\n(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\n(c) a description of the dental plan's utilization review procedures, including:\n(i) a procedure for an enrollee of the dental plan to obtain review of an adverse determination in accordance with Section 31A-22-629; and\n(ii) a statement of a provider's rights and responsibilities regarding the procedures described in Subsection (3)(c)(i).\n(4) An insurer may not maintain a dental plan that:\n(a) based on the provider's contracted fee for covered services, uses downcoding in a manner that prevents a dental provider from collecting the contracted fee for the actual service performed from either the plan or the patient;\n(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;\n(c) does not allow a dental provider to seek payment of the contracted fee for a covered service from the patient when the insurer denies payment for the service, unless under generally accepted practice standards, the service performed should not be billed; or\n(d) beginning January 1, 2026, automatically recoups an overpayment unless:\n(i) the recoupment occurs more than 60 days from the day the insurer sends a notice of the overpayment; or\n(ii) the dental provider affirmatively elects to have recoupment occur earlier than 60 days from the day the insurer sends a notice of the overpayment.","path":["Title 31A Insurance Code","Chapter 31A-26 Insurance Adjusters","Part 31A-26-3 Claim Practices"],"source_url":"https://le.utah.gov/xcode/Title31A/Chapter26/31A-26-S301.7.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"e185fd122092f5d8169ed0dc62a545da3f20caa6c14e5ac113a7b008a053df05","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-26-301.6","next":"us-ut/utah-code-31a-26-301.8"},"notice":"GroundRules: Original legal text. Not legal advice."}