Interoperability
Utah Medicaid has developed a provider directory to assist members in finding an available provider. The new directory, Find a Provider, lists all physicians and advanced practice providers who serve Medicaid members. Members will now be able to search for a provider by name, type, specialty, and location. This provider directory is now available here.
This is in accordance with Section 5006 of the 21st Century Cures Act amended § 1902(a) of the Social Security Act requires states to provide an online provider directory for Medicaid members. Federal law requires that specific information be made available to the public. Most of the information in the provider directory will come from Utah Medicaid’s Provider Enrollment System.
For the best user experience, members need to be able to find accurate provider contact information and understand which providers are accepting new clients. Provider data can be updated in the PRISM provider enrollment system. To improve the accuracy of data, Utah Medicaid has added the following fields to PRISM for each location:
- Public Phone Number
- This is intended to be your preferred phone number for public contact. This is a required field. We are asking you to update this information at your earliest opportunity.
- Public Email Address
- This is intended to be your preferred email contact for the public, if you want to provide one. This is an optional field. We ask you to update at your convenience.
- Accepting New Clients
- This field already exists for Individual/Sole Proprietor Applicant Types. We will be adding the field so it is available for these additional Enrollment Types:
- Group Practice
- Facility/Agency/Organization
- Atypical Agency
- Atypical Individual
- We ask you to update this field at your convenience. Until this is identified as “Yes” or “No” by providers, it will be blank.
- This field already exists for Individual/Sole Proprietor Applicant Types. We will be adding the field so it is available for these additional Enrollment Types:
We greatly appreciate your participation in this project.
Utah Medicaid has developed a provider directory to help members find an available provider. This new directory, Find a Provider, lists all physicians and advanced practice providers who serve Medicaid members. Members will now be able to search for a provider by name, type, specialty, and location. Check out the new directory here.
Utah Medicaid is also developing Application Programming Interfaces (API) that will allow members to search for providers and access their history of Medicaid services through a third party application. We will provide more information about this development at a later date.
In accordance with the Patient Access and Interoperability final rule (CMS-9115-F), Utah Medicaid is implementing a Fast Healthcare Interoperability Resources (FHIR) standards-based solution to store, share, and retrieve Patient Access and Provider Directory Application Programming Interface (API) data. This project will allow Medicaid members to have access to clinical, claims and other health data via third-party applications.
For more information visit: