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  • Utah Medicaid Documentation Submission Form - Utah Department ... - Health Utah

Get Utah Medicaid Documentation Submission Form - Utah Department ... - Health Utah

Utah Medicaid Documentation Submission Form Please check the type of documentation you are submitting Emergency Only Documentation Fax 801-536-0475 Manual FaxReview Documentation 801-536-0463 Timely Filing Documentation EOB FaxFax non-Medicare 801-536-8513 Medicare 801-323-1584 Consent Form Fax 801-237-0745 Other Documentation Please fill out as much information as you have regarding the documentation being submitted. Claim Date TCN Billing P.

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An application will need to be submitted using the PRISM online application process found at https://medicaid.utah.gov/become-medicaid-provider/. Once the application has been submitted, please email providerenroll@utah.gov with your request.

Contact Utah Medicaid For member concerns or complaints, contact the Division of Integrated Healthcare Constituent Services Representative at (801) 538-6417 or 1-877-291-5583 or email medicaidmemberfeedback@utah.gov. For web site issues or questions, please email MedicaidOps@utah.gov.

First, you should open the following link: “Ohio Medicaid Online Application” to access Ohio Medicaid's online application. From the main screen, you will need to select the “New Provider” button located on the top right side of the home page screen. On the next screen you will be asked to select your application Type.

UTAH MEDICAID INFORMATION In the Salt Lake City area, call (801) 538-6155. In Utah, Idaho, Wyoming, Colorado, New Mexico, Arizona, and Nevada, call toll-free 1-800-662-9651. From other states, call 1-801-538-6155.

The expansion extends Medicaid eligibility to Utah adults whose annual income is up to 138% of the federal poverty level ($17,608 for an individual or $36,156 for a family of four). The federal government covers 90% of the costs for these services, with the state covering the remaining 10%.

You must renew your eligibility by reporting your income to DWS....Renewing your Medicaid Benefits By Phone: Toll-Free (866) 435-7414. By Mail: Complete the form that DWS sent you and mail back to the DWS office. ... In Person: Visit jobs.utah.gov/mycase/ and type in your local zip code to find the DWS office closest to you.

UTAH MEDICAID INFORMATION In the Salt Lake City area, call (801) 538-6155. In Utah, Idaho, Wyoming, Colorado, New Mexico, Arizona, and Nevada, call toll-free 1-800-662-9651. From other states, call 1-801-538-6155.

These courses describe how to enroll as a new Utah Medicaid Provider depending on the enrollment type. If you have questions, please call Provider Enrollment at (801) 538-6155, or toll-free 1-800-662-9651 (option 3 then 4) or by email: providerenroll@utah.gov.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232