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Provider Relations

doctor high-fiving young patient

Provider Relations

Provider Relations Contact Information

HCU Provider Relations Territory Map

Provider Relations (Office)

  • Escalated provider issues
  • Provider contracting questions
  • Hospice Services
  • Claims concerns not addressed by Customer Service

Network Services Representative Map 
providers@healthchoiceutah.com 
Fax: 801-646-7207

Provider Network Service Representatives

Amy Prince - Territory Map

Amy Prince

Provider Network Service Representative


Primary contact for contracting, demographic updates, credentialing, and claim concerns for providers and hospitals in: Carbon, Emery, Grand, Salt Lake, and San Juan Counties.


Network Services Representative Map

Primary contact throughout Utah for:
  • Intermountain Healthcare
  • Home Health Agencies
  • Hospice Services
  • Personal Care Agencies

Kayanne Malin - Territory Map

Kayanne Malin

Provider Network Service Representative


Primary contact for contracting, demographic updates, credentialing, and claim concerns for providers and hospitals in: Beaver, Garfield, Iron, Juab, Kane, Millard, Piute, Sanpete, Sevier, Utah, Washington, and Wayne Counties.

Network Services Representative Map

Primary contact throughout Utah for:
  • HCA MountainStar Hospitals and Physicians
  • Holy Cross Hospitals and Physicians
  • Durable Medical Equipment Companies
  • Laboratory Services

Lisa DeKarver - Territory Map

Lisa DeKarver

Provider Network Service Representative


Primary contact for contracting, demographic updates, credentialing, and claim concerns for providers and hospitals in: Box Elder, Daggett, Davis, Duchesne, Rich, Morgan, Summit, Tooele, Uintah, Wasatch, and Weber Counties.

Network Services Representative Map

Primary contact throughout Utah for:
  • University of Utah Hospitals and Clinics
  • Skilled Nursing Facilities
  • Long-Term Acute Care Hospitals
  • Dialysis Centers

Provider Information Update Form

In order to process the update, include any associated provider(s) and NPI(s) number(s) that we need to have listed under the change.

Please submit a provider roster, W-9, or other necessary documentation below. This information is typically required to complete this request.
Important: Submission Instructions for Provider Documentation
Due to security constraints, providers are currently unable to attach documentation directly to the Provider Information Update Form. Until further notice, please submit any accompanying documentation (rosters, W9 forms, etc.) via email to: provider.relations@hsc.utah.edu

To help ensure documents are received and processed efficiently:

  • Complete and submit this form (Note: A copy of the form submission & values will be emailed upon submission)
  • In the subject Line, please include Form Submission ID: cd3d454e-0873-4897-b1f2-a8876d8fd75d, as well as, the provider or organization name.
  • To help ensure documents are received and processed efficiently, please combine multiple files into a single ZIP or other archive file whenever possible before sending your email.

Anything with a * next to it is a required field.


CONTACT INFORMATION

EXISTING ADDRESS
EXISTING BILLING ADDRESS

PRACTICE INFORMATION

* ASSOCIATED PROVIDER: (IF MULTIPLE PROVIDERS, ATTACH INFORMATION AS A SPREADSHEET OR OTHER FORM OF ROSTER BEFORE SUBMITTING THIS FORM.)

NEW PRACTICE ADDRESS
(PICK ALL THAT APPLY)

Website URL: By providing the URL to your clinic website, you give Health Choice Utah permission to publish a link to your site in our provider directories. Health Choice Utah assumes no responsibility or liability for the information displayed on your site.

NEW BILLING ADDRESS