31A-26-301.8. Non-covered dental services and claims documentation.
285 words·~1 min read·
/ut/title-31a/chapter-26/31a-26-301-8·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Effective 5/6/2026
31A-26-301.8. Non-covered dental services and claims documentation.
(1)Terms defined in Section 31A-26-301.7 apply to this section.
(2)An insurer may not require a dental provider to submit the dental provider's full fee-for-service charges on a claim form as a condition of payment or processing if:
(a)the dental provider disclosed the dental provider's full fee schedule during credentialing, contract negotiation, or renewal; and
(b)the contract includes a contracted fee schedule for covered services.
(a)If an insurer requires submission of a claim form, a dental provider may report:
(i)the contracted fee; or
(ii)the dental provider's fee for service.
(b)An insurer may not penalize a dental provider because of the dental provider's choice under Subsection (3)(a) .
(4)If an insurer determines that a provided dental service is not a covered service, the insurer shall issue an explanation of benefits to the dental provider and patient that:
(a)clearly states that the procedure code is not covered under the dental plan; and
(b)does not describe the unreimbursed amount as a required contractual adjustment or mandatory write-off.
(a)An insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result.
(b)A dental provider who receives an overpayment from a dental plan shall return the amount of the overpayment through check or other means to the dental plan within 60 days from the day the insurer sends a notice of the overpayment.
(6)An insurer's failure to comply with Subsection
(4)does not prevent a dental provider from billing and collecting payment from a patient for a non-covered service.
Enacted by Chapter 45 , 2026 General Session