Of Health Division of Health Care Financing - health utah 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Claim or Encounter Identifier in the designated field. This is crucial for tracking your submission.
3. Fill out the Submitter Primary Identification Number, which should be your Electronic Address or Trading Partner Number (TPN).
4. In the Receiver section, input 'Utah Medicaid - MCO' as the Receiver Name and ensure you enter the correct Receiver Primary Identifier.
5. Complete the Billing Provider section with your details, including last name, first name, and NPI number. Make sure to include any required Taxonomy Codes if applicable.
6. Proceed to Patient Information and accurately fill in all fields such as Patient Last Name, First Name, Date of Birth, and Gender Code.
7. Finally, review all entries for accuracy before submitting your form through our platform for processing.

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