UTAH SPECIFIC TRANSACTION INSTRUCTIONS
(Companion Guides)

HIPAA transaction and code set requirements are outlined in the National Electronic Data Interchange Transaction Set Implementation Guides. Companion guides have been created outlining supplemental requirements specific to Utah Medicaid, as permitted within the structure of the HIPAA transaction sets. The guides will be updated as implementation of each transaction occurs. The most current version will be available on the website. All providers who submit claims electronically to Utah Medicaid must adhere to the HIPAA Implementation Guide, the Utah Specific Transaction Instructions (Companion Guide), and policy contained in the provider manuals.

• 5.1 – NCPDP
• 837 – Health Care Claim (Professional, Institutional, Institutional–LTC, Dental )
• 835 – Health Care Claim Payment/Advice
• 278 – Health Care Services Review – Request for Review & Response
• 276/277 – Health Care Claim Status Request and Response
• 270/271 – Health Care Eligibility Benefit Inquiry & Response
• 837 – Encounter Records (Professional, Institutional)
• 820 – Payroll Deducted and Other Group Premium Payment
• 834 – Benefit Enrollment and Maintenance