Patient Eligibility Verification

Starting May 1, 2023, DHHS will begin issuing a new Medicaid card to replace the old Utah Department of Health (UDOH) card for newly enrolled Medicaid members. Each new Medicaid member will get their own card.  Existing members will continue to use their old UDOH Medicaid card. Please accept both DHHS and UDOH Medicaid cards. Learn more in the New Medicaid Card FAQ for Providers.

Utah Medicaid has recently upgraded our security for the Eligibility Lookup Tool. All users must re-register in order to use the system. Please use the same email address to link your account. To register, click here.

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 by creating an account.  If not currently logged in, you will be redirected and prompted to log in.  Due to security, there is a 20-minute inactivity timeout feature on the Eligibility Lookup Tool.

Currently, the Eligibility Lookup Tool does not display correct PRISM benefit plan assignments. Beginning April 10, 2023, the Eligibility Lookup Tool will display the correct PRISM benefit plans for members. In the meantime, providers can use the Eligibility Inquiry functionality in PRISM to search for member benefit plans. For more information please see the Member Eligiblity Inquiry in PRISM Reference Guide

Eligibility Lookup Tool