type of enrollment is for providers who order, refer, or
prescribe to Medicaid clients. This type of enrollment does
not allow Medicaid to reimburse you for your services. For
more information, please call Provider Enrollment at 1-801-538-6155,
or toll-free 1-800-662-9651
(option 3 then 4).
who wish to enroll as an ordering, referring, or prescribing
provider must fill out each required document in its entirety
and mail or fax to the address below. Please
write on top of application whether you are an ordering,
referring, or prescribing provider.
Bureau of Medicaid Operations
Lake City UT 84114-3106
Fax: (801) 536-0471