The criteria below have been archived. They have been alphabetized for your convenience. If you have questions, contact the webmaster or call Medicaid Information at (801) 538-6155 or 1-800-662-9651.
All documentation that is required must be attached in addition to the Prior Authorization Request Form located on the Forms page.
Cannon Health Building
288 North 1460 West
Salt Lake City, UT 84116