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  • Payment Adjustment Request Form - Utah Medicaid - Utah.gov

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Utah Medicaid Provider Manual Division of Medicaid and Health Financing Payment Adjustment Request Form Issued July 2015 Payment Adjustment Process A new electronic Payment Adjustment Request form.

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Providers: When a provider wishes to appeal a payment reflected by an explanation of benefits, or other remittance document issued by Medicaid, the hearing request must be filed within 30 calendar days of the date of the remittance document.

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%.

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.

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.

Utah Medicaid POS 72-hour override When a medical emergency occurs for a medication that requires prior authorization, a pharmacy provider may dispense up to a 72-hour supply of the medication without obtaining prior authorization.

To File an Appeal If you need help filing your appeal, call us at 801-587-6480. If you are deaf or hard of hearing, you can call Utah Relay Services at 711 or 1-800-346-4128.

You may have to pay Medicaid back if: Recovery can only be made if at the time of death, you have no surviving spouse, no child under the age of 21, or no child who is blind or disabled. Recovery is limited to the amount of medical assistance provided for you when you were 55 years of age or older.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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
Content Takedown Policy
Bug Bounty Program
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:
+1 833 426 79 33
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