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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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