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

Filling out the Utah Medicaid Documentation Submission Form accurately is essential for proper processing of your documentation. This guide provides a clear, step-by-step approach to help you complete the form efficiently and effectively.

Follow the steps to successfully submit your documentation online.

1. Click 'Get Form' button to obtain the form and open it in the editor.
2. Begin by checking the type of documentation you are submitting. You may select from options such as 'Only Documentation', 'Emergency', 'Manual Fax Review', 'Timely Fax Filing', 'EOB Fax', 'Consent', or 'Other Documentation'. Each option may require you to fax your submissions to specific phone numbers.
3. Fill out the information section with details regarding the documentation being submitted. Provide as much information as possible to ensure your submission is processed correctly.
4. Complete the required fields marked with an asterisk (*). These include the 'Billing Provider NPI', 'Recipient ID', 'Date of Service' and any other pertinent information that will facilitate accurate matching.
5. Optionally, fill in the 'Notes/Comments' section for any additional information that could assist in processing your submission.
6. Once all sections are filled out, review your entries for accuracy. Make sure that all required information is provided.
7. After final review, you are ready to save your changes. You can download, print, or share the form as needed for your records.

Complete your documentation and submit the Utah Medicaid Documentation Submission Form online today.