Contact Information for Providers

Find out if a patient is covered by Medicaid or PCN, the months of eligibility, co-payment/co-insurance, and in which ACO the patient is enrolled.

• Patient Eligibility Confirmation

Prior Authorizations

For questions regarding Utah Medicaid Fee for Service Prior Authorizations, contact us:

By Phone

(M, W, Th, F 8am-5pm, Tuesday 11am-5pm)

• In the Salt Lake City area, call (801) 538-6155
• In Utah, Idaho, Wyoming, Colorado, New Mexico, Arizona and Nevada, call toll-free (800) 662-9651
• From all other states, call (801) 538-6155
• For Prior Authorizations choose option 3, 3 and then the appropriate program

By Fax

See page 3 of the Prior Authorization Request Form

Claim Inquiries

• Use ANSI 276/277 or call Medicaid Information Line: 1-800-662-9651
• Medicaid Crossover Claims: SECTION 1, Chapter 11 – 6, of the Utah Medicaid Provider Manual. opens in a new tab

Hearings for Providers and Peer Review

When a Medicaid member, provider, or other interested party is dissatisfied with an action taken by Utah Medicaid, a hearing may be requested by filing a hearing request with the Office of Formal Hearings to appeal the action. For more information or to contact the Office of Formal Hearings, click here.

• Procedures for Provider Hearing: SECTION 1 – General Information Provider Manual opens in a new tab
• Procedures for Peer Review: SECTION 1 – General Information Provider Manual opens in a new tab