Medicaid Fair Hearings
When a Medicaid member, provider, or other interested party is dissatisfied with an action taken by Utah Medicaid, a hearing may be requested by filing a hearing request with the DHHS Office of Administrative Hearings (OAH). Hearing requests to Medicaid include requests to dispute disability decisions made by the DHHS Medical Review Board (MRB). For non-Medicaid hearings visit our human services administrative hearings page.
Hearing requests must be filed by the filing deadline
- Providers: When a provider wishes to appeal a payment reflected by an explanation of benefits, or other remittance document issued by Medicaid, the hearing request must be filed within 30 calendar days of the date of the remittance document.
- Members: When a member wishes to appeal a Medicaid or CHIP eligibility or disability decision, the hearing request must be filed within 90 days from the date of the notice they disagreed with.
Managed care plan hearing request
A member or provider wishing to dispute an action taken by an Accountable Care Organization or Managed Care Entity must complete the appeal process within that organization before filing a hearing request with OAH.
Medicaid eligibility fair hearing requests
Although OAH handles hearing requests to dispute disability decisions made by the MRB, OAH does not handle disputes regarding eligibility decisions for Medicaid or CHIP. Fair hearings for Medicaid and CHIP eligibility should be filed with the Department of Workforce Services (DWS), Division of Adjudications here.
How to request a Medicaid fair hearing
You can fill out the State Fair Hearing Request Form available here, and email the form as an attachment to [email protected].
If you prefer to mail your request, you may use the mailing addresses listed below:
Mailing Address:
Department of Health and Human Services
Office of Administrative Hearings
PO Box 143105
Salt Lake City, UT 84114-3105
If you have any questions about your request, contact the Office of Administrative Hearings using one of the methods below:
Email: [email protected]
Phone: 801-538-6576
Fax: 801-536-0143
Street Address:
Department of Health and Human Services
Office of Administrative Hearings
195 North 1950 West
Salt Lake City, UT 84111
Additional information
Additional information on fair hearings is contained in the Utah Medicaid Provider Manual, General Information – Section I, Chapter 5, section 4 (pg. 35)-4.