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.
Prior Authorization and Appeals Processes
- For guidelines about preauthorization, click here.
- Click here for a full list of all procedure codes requiring preauthorization.
- For information on obtaining approval of MRIs, click here.
- Click here for a preauthorization form for medical services
- Click here for a preauthorization form for medicationClick here
- 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
- 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
- Please fax inpatient notifications to 1-801-262-0103
- Please fax outpatient prior authorization requests to 1-801-213-1358
- Click here for a copy of our new provider manual. The manual includes information and guidance on provider credentialing.
- 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 406-447-5799
- 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