What is prior authorization?
Prior authorization (PA) means the health plan must approve certain care before it will cover it. Providers often submit requests for you, but you still have rights if PA is denied or delayed.
Overview: Prior authorizations. Utah-only details below.
Confirm plan type: Utah: Start Here.
Utah PA rules
Utah regulates preauthorization primarily through Utah Code § 31A-22-650 and related Title 31A provisions. These rules generally apply to UID-regulated health benefit plans—not Medicare, typical self-funded ERISA plans, or many federal programs.
Current law (§ 31A-22-650)
- No preauthorization for emergency care
- Insurers must give 30 days' advance noticebefore modifying an existing PA requirement and post notice on the insurer's website
- Insurers must notify network providers of PA requirement changes upon request
- Adverse PA determinations must include required notice content (clinical rationale, criteria, billing codes, and related information per statute)
- Annual reporting to UID on PA approvals, denials, and related metrics
Step therapy exceptions (§ 31A-22-645)
Insurers must provide a process for providers or enrollees to request exceptions to step therapy protocols when medically appropriate.
Pending reform (SB 319, effective January 1, 2027)
SB 319 further amends § 31A-22-650 to strengthen PA transparency, response timelines, minimum authorization durations (often 6 months outpatient / 12 months chronic), limits on retroactive denials after approved care, and enhanced public reporting. As of mid-2026, confirm whether SB 319 is in effect for your denial date.
Federal deadlines (many Marketplace and group plans)
Federally regulated plans often follow CMS timing: 72 hours for urgent PA and 7 calendar days for standard requests—check your plan documents.
Where to look up PA rules
Check your plan materials and the carrier's provider or member portal first.
Carrier links: Utah prior auth & internal appeals links.
Medicaid
Utah Medicaid managed care follows federal and state utilization management rules through MCO grievance and appeal systems—not commercial § 31A-22-650 PA rules for most member benefit disputes.
If PA is denied
Appeal the adverse benefit determination through your plan's internal appeal process, then independent review if needed.
Next: Utah internal appeals.
Urgent care
Emergency care cannot require prior authorization under Utah law. For urgent non-emergency disputes, federal and plan rules often require expedited internal and independent review within 72 hours when delay would seriously jeopardize life or health.