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 still need to complete the PRISM online enrollment.
Creating a Utah ID Account
A provider will have to register with the State of Utah by creating a Utah-ID Account. If you have a Utah-ID and password, simply log in to access the PRISM Portal. Click here for more information and instructions if you have not previously created a Utah-ID account.
PLEASE NOTE THAT ONLINE APPLICATIONS WILL BE PURGED AFTER 60 DAYS IF NOT COMPLETED AND SUBMITTED.
New Enrollment Application and Track Your Application
To become a Utah Medicaid Provider or to track your application click on the PRISM Portal.
For assistance on how to enroll as a new Medicaid provider, please refer to the Enrolling as a New Medicaid Provider eLearning courses. These courses describe how to enroll as a new Utah Medicaid Provider depending on the enrollment type.
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.
Additional Forms for Providers: