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| General Information |
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| Personal Health Concerns |
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| Claim Questions? |
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: 801-366-7555 |
| : 800-765-7347 |
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Provider Manual - Appeals Process
If the Provider disagrees with PEHP’s action, the Provider may request a full and fair review by writing to the Medical Review Committee within 180 days after receiving notice of denial.
Appeals should be mailed to:
Medical Review Committee
Public Employees Health Program
560 East 200 South
Salt Lake City, Utah 84102-2004
If the Provider disagrees with the decision or action taken by the Medical Review Committee, he/she has the right to request an Administrative Review. Upon written request, including receipt of any pertinent additional information or comments, the Administrative Review Committee will commence an investigation. Written notification of the outcome will be mailed to the Provider.
If a Provider is not satisfied with a decision of the Administrative Review Committee, an appeal in writing may be sent to the Executive Director of Utah Retirement Systems, stating the facts of the situation, the remedy desired, and the basis in law or equity which warrants it. The Executive Director will review the case and either grant or deny the request.
If request for appeal is denied by the Executive Director, a Provider may, within 30 days of the denial, file a written petition with the hearing officer in accordance with the procedure set forth in Utah Code Ann. 49-11-613. Provider must file the petition to the hearing officer on a standard form provided by and returned to the Retirement Office. Once the hearing process is complete, the hearing officer will prepare an order for the signature of the Utah Retirement Board President and submit it to the Executive Director within 30 days.
Should the Provider disagree with the decision of the hearing officer, he/she may either petition the Board for reconsideration or directly appeal to the Utah Court of Appeals within 30 days.
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