{"data":{"id":"us-ut/utah-code-31a-26-301.8","jurisdiction":"us-ut","citation":"Utah Code § 31A-26-301.8","heading":"Non-covered dental services and claims documentation.","body":"(1) Terms defined in Section 31A-26-301.7 apply to this section.\n(2) An insurer may not require a dental provider to submit the dental provider's full fee-for-service charges on a claim form as a condition of payment or processing if:\n(a) the dental provider disclosed the dental provider's full fee schedule during credentialing, contract negotiation, or renewal; and\n(b) the contract includes a contracted fee schedule for covered services.\n(3)\n(a) If an insurer requires submission of a claim form, a dental provider may report:\n(i) the contracted fee; or\n(ii) the dental provider's fee for service.\n(b) An insurer may not penalize a dental provider because of the dental provider's choice under Subsection (3)(a).\n(4) If an insurer determines that a provided dental service is not a covered service, the insurer shall issue an explanation of benefits to the dental provider and patient that:\n(a) clearly states that the procedure code is not covered under the dental plan; and\n(b) does not describe the unreimbursed amount as a required contractual adjustment or mandatory write-off.\n(5)\n(a) An insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result.\n(b) A dental provider who receives an overpayment from a dental plan shall return the amount of the overpayment through check or other means to the dental plan within 60 days from the day the insurer sends a notice of the overpayment.\n(6) An insurer's failure to comply with Subsection (4) does not prevent a dental provider from billing and collecting payment from a patient for a non-covered service.","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-S301.8.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"84c71484ff69889bfa0b6d6eb7beb14306852b76dfe6cc9ede7dcddcb2d67d88","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-31a-26-301.7","next":"us-ut/utah-code-31a-26-302"},"notice":"GroundRules: Original legal text. Not legal advice."}