Policies

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.

Provider Manual

  • Click here for a copy of our new provider manual.

Prior Authorization and Appeals Processes

  • For a list of services requiring preauthorization, click here for guidelines.  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 Submission

  • 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

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