Eligibility

The Eligibility Lookup Tool is a website that allows a provider to electronically view a member’s Medicaid eligibility and plan enrollment information.  The Eligibility Lookup Tool will also tell you if the patient is restricted to a specific provider and if the patient is responsible for co-pays.

To verify your patient’s eligibility on the portal you will need the information off of the Medicaid card which includes member’s name, Medicaid ID and date of birth.  A provider must also have a Provider ID (NPI or API) known to Medicaid.

In order to be in compliance with HIPAA, we must assure that only those that have the right to this information have access.  A provider will have to register with the State of Utah Master Directory (UMD).  If not currently logged in, you will be redirected and prompted to login.  If you have a Utah-ID and password, simply login to access the Eligibility Lookup Tool.  See below for more information if you have not previously created a UMD account.

Eligibility Lookup Tool

Non-State users of the Utah Medicaid Provider Eligibility Look up Tool will be required to change their passwords as of 6/9/2015 and then every 90 days there after. All password requirements are available on the Utah-ID account maintenance web site. Call (801) 538-5779 if you have any questions.

If you do not currently have a Utah-ID and password, you will be required to create an account before accessing the Eligibility Lookup Tool.  Create an account by following these instructions:

  1. Under the Utah-ID page "Login" button, click on the "Create Account" link.
  2. Create a Utah-ID.
  3. Enter your first and last name.
  4. Enter a valid email address and verify by re-entering below the original.
  5. Create a password and verify by re-entering your password below the original.
  6. Click the "Create Account" button.
  7. Select three security questions and provide answers for each question. 

Once you have created a new account, an email will be sent to the address you have entered that contains a validation code.  When prompted, you will need to enter this code.  If for some reason you have not received a validation code when prompted, you may bypass the activation step for up to three times.  Occasionally, due to the permissions process, it takes up to an hour from the time an account has been created to the time the user is allowed to access the Eligibility Lookup Tool.