Get Version 3.3 - Utah Department Of Health - Utah.gov - Health Utah

This guide provides comprehensive and clear instructions on how to fill out the Version 3.3 form from the Utah Department of Health. It aims to support users in navigating the online health eligibility and benefits inquiry process seamlessly.

Follow the steps to easily fill out the form online.

1. Click the ‘Get Form’ button to acquire the form and open it for editing.
2. Begin by reviewing the eligibility inquiry section, where you will input necessary identifiers such as your National Provider Identifier (NPI) and Medicaid contract numbers in the specified fields.
3. Ensure you fill in the subscriber's information accurately, including their last and first names as they appear on their Medicaid card.
4. Provide the subscriber's birth date in the correct format (CCYYMMDD) and ensure the date is consistent with the Medicaid records.
5. If applicable, include service type codes based on the benefits inquiry you are making to ensure the response returns appropriate information.
6. Submit your eligibility inquiry online. Remember that inquiries can be made 24/7, but responses will take time, especially during the claims adjudication process on weekends.
7. After submission, you will receive a Functional Acknowledgment within two hours. If no acknowledgment is received, follow up to confirm your transmission was successful.
8. You can save changes, download, print, or share the form as needed after completion to keep a record of your submission.

Complete your documents online today for a streamlined process.