GENERAL ATTACHMENTS
Updated March 2013

A complete Utah Medicaid Provider Manual includes the attachments listed below. 

Access Now Instructions/Fax Numbers
Guide to Medical Interpretive Services
CMS -1500 Instructions (provided by UHIN)
Coordination of Benefits
Medicaid Identification Cards
Medicaid Information Line Menu
Telephone Menu Options
Prepaid Mental Health Plans
Prior Authorization Request Form Instructions
Documentation Submission Form
Publications Request Form
Request for Hearing Form
Request for Hearing Form (Español)

To request a copy of an attachment, contact Medicaid Information or send an e-mail message to: medicaidops@utah.gov .  State which specific attachment you want and whether you prefer electronic or printed format.  Electronic format can be sent to you via e-mail.  Printed format can be faxed or mailed.