Allergy & Immunology Billing Services in Utah

Utah's healthcare market includes 8,000+ physicians, and allergy & immunology practices here face a payer market dominated by SelectHealth (owned by Intermountain Health) on the commercial side and Utah Medicaid (managed care administered through four Accountable Care Organizations) on the public payer side. Medicare claims are processed through Noridian Healthcare Solutions (Jurisdiction F), which applies its own Local Coverage Determinations that directly affect allergy & immunology procedure coverage and medical necessity requirements. Generic billing teams without UT specific knowledge leave revenue on the table.

Allergy & Immunology billing itself is complex. Allergy and immunology billing revolves around allergy testing codes (95004 percutaneous, 95024 intracutaneous, 95044 patch testing), immunotherapy administration (95115-95117 for injections, 95120-95134 for professional services with provision of antigen), biologic medication J-codes for severe allergic conditions, and pulmonary function testing (94010-94070). Test count accuracy is critical — each allergy test is billed per individual allergen, and a typical testing session involves 40-80 individual tests. When you combine this coding complexity with Utah's specific payer rules, authorization requirements, and 4 Utah Medicaid (managed care administered through four Accountable Care Organizations) managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving allergy & immunology practices from Salt Lake City to West Jordan and across Utah.

Utah has about 8,000 physicians and a Medicaid managed care program that uses four Accountable Care Organizations (ACOs) rather than traditional MCOs. The four ACOs are HealthChoice of Utah, Healthy U (operated by University of Utah Health Plans), Molina Healthcare of Utah, and SelectHealth Community Care (an Intermountain Health subsidiary). Mandatory enrollment in an ACO has applied to members in urban counties since 1995, and expanded in 2015 to include nine additional rural counties. Behavioral health and dental services are carved out of the ACO contracts and offered through other managed care entities. The commercial market is dominated by SelectHealth, the insurance arm of Intermountain Health. SelectHealth holds significant market share statewide because Intermountain operates as an integrated payer-provider. Regence BlueCross BlueShield of Utah is the second largest carrier. Salt Lake City is anchored by Intermountain Health (which merged with SCL Health in 2022 to expand into Colorado and Montana), University of Utah Health, and HCA Healthcare's MountainStar Healthcare. Utah expanded Medicaid via ballot initiative in 2018 but implementation was delayed by the legislature.

Utah-specific factors that shape allergy & immunology reimbursement: Utah uses Accountable Care Organizations rather than traditional MCOs for Medicaid managed care. ACOs are typically affiliated with major health systems like Intermountain or University of Utah.; SelectHealth is the insurance arm of Intermountain Health and holds dominant commercial market share in Utah. The integrated payer-provider model is one of the strongest in the country.; Intermountain Health merged with SCL Health in 2022 to form a multi-state nonprofit system. The merger expanded Intermountain into Colorado, Montana, and Wyoming.. Our UT coders build these into every allergy & immunologyclaim — see how this works alongside our Utah medical billing and allergy & immunology billing teams.