Get Version 6 Utah Specific Transaction Instructions - Utah Department ... - Health Utah

This guide provides clear and user-friendly instructions for completing the Version 6 Utah Specific Transaction Instructions form for the Utah Department of Health. Whether you are familiar with digital forms or utilizing them for the first time, this step-by-step guide will assist you in accurately filling out the necessary information.

Follow the steps to successfully complete your form

1. Click ‘Get Form’ button to access the Utah Specific Transaction Instructions document and open it in your preferred digital format.
2. Review the requirements including the Electronic Commerce Agreement, which must be established before beginning the form; this agreement is available through the Utah Health Information Network.
3. Ensure you have completed the Utah Medicaid EDI Enrollment application, which is required before submitting an 834 Benefit Enrollment and Maintenance form.
4. Begin filling out the first section, starting with the 'Action Code.' Choose from options such as '2' for update or '4' for synchronization based on your needs.
5. Continue to enter information for the 'Master Policy Number,' 'Plan Sponsor Name,' and 'Maintenance Type Code' in the subsequent fields as specified in the guide.
6. Complete key sections including the insured individual's details, subscriber information, and any applicable communication numbers.
7. Review all entered information thoroughly to ensure accuracy, including personal details, addresses, and relevant codes specified in the document.
8. Once you have filled out all necessary fields, finalize the form by saving any changes you made, and download or print the document as needed.

Complete your documents online today to ensure compliance and proper processing.