MHC is pleased to be partnering with the University of Utah Health Plans as our third party administrator effective January 1, 2018.
With this change, there are a number of changes to our various interactions with our providers. Below are these changes, as well as some resources to learn more and ask additional questions.
- Click here for a copy of our new provider manual.
Prior Authorization and Appeals Processes
- For guidelines about preauthorization, click here.
- Click here for a complete list of procedure codes requiring preauthorization.
- Click here for guidelines for coverage of MRIs.
- Click here for a preauthorization form for medical services
- Click here for a preauthorization form for medications
- Click here for a preauthorization form for Synagis
- Click here for a formulary exception form
- Click here for a preauthorization form for hospice care
- Click here for a preauthorization form for home health care services
- Click here for a preauthorization form for skilled nursing facility and acute rehab care
- Click here for a consent form allowing you to appeal on behalf of your patient
- Click here for the appeal form
- For patient eligibility and benefits, please call 1-844-262-1560
- For prior authorizations for medical services, please call 1-801-587-2851
- For prior authorizations for prescription drugs, please call 1-866-236-5976
- For questions about appeals, call 1-855-447-2900
- Claims should be submitted through the Utah Health Information Network (UHIN). For more information on this process, click here for a Q & A on how to submit claims.
- Visit http://www.uhin.org for more information
Utilization Management Medical Policies
- We would be happy to provide you with a copy of the criteria we use to make utilization management decisions. Please contact the UM team at 801-587-6480 or 888-271-5870, Option 2, for additional information. You may also email your request for criteria to UUHP_UM@hsc.utah.edu
New Provider Portal
- The new provider portal gains you access 24 x 7 to claims information, patient eligibility, medical policies and contact information
- How to gain access to the provider portal
- Please email MHCProviderRelations@hsc.utah.edu to obtain your login information
Receiving Funds From MHC
- We must have a W-9 on file before we can make any payments to you
- You can fax your W-9 form to 208-577-6241
- If we do not have a direct deposit set up for your group, we will send a paper check
- Click here for instructions on how to set up electronic funds transfer (EFT) payment
Preferred Drug List