Thank you for your interest in participating as a Medicaid provider. To become a Medicaid provider, you must complete the PRISM online enrollment and submit the required forms and documents. If you do not wish to be reimbursed by Medicaid for your services but would still like to order, refer or prescribe to Medicaid members, you will need to complete the PRISM online enrollment.
PLEASE NOTE THAT ONLINE APPLICATIONS WILL BE VOIDED AFTER 60 DAYS IF NOT COMPLETED AND SUBMITTED.
Use this link to enroll online to become a Utah Medicaid Provider. If your provider has been closed in PRISM and you would like to re-enroll, please log in to the Provider Portal.
For assistance on how to enroll as a new Medicaid provider, please refer to the Enrolling as a New Medicaid Provider Web-Based Trainings. These trainings describe how to enroll as a new Utah Medicaid Provider depending on the enrollment type.
Use this link to return to your incomplete application to finish and submit for review.
A provider will have to register with the State of Utah by creating a Utah-ID Account. If not currently logged in, you will be redirected and prompted to log in. If you have a Utah-ID and password, simply log in to access the New Enrollment Application or Track Application links. Click here for more information and instructions if you have not previously created a Utah-ID account.
If you have questions, please call Provider Enrollment at (801) 538-6155, or toll-free 1-800-662-9651 (option 3 then 4) or by email: firstname.lastname@example.org. Do not send protected health information (PHI) to this email address.
If you are unable to complete the online enrollment process, you can access the paper application and forms here. To submit the paper application use the Provider Enrollment Coversheet and send the application and all required forms.
Bureau of Medicaid Operations Provider Enrollment
P.O. Box 143106
Salt Lake City, UT 84114-3106
By Fax: (801) 536-0471
Additional Forms for Providers: