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Welcome to SelectHealth Community CareSM

On January 1, 2013, SelectHealth Community Care became a managed Medicaid option in four counties along the Wasatch front. This plan, along with SelectHealth Advantage (Medicare), will be the first plans to have shared accountability between SelectHealth and Intermountain HealthcareR. This means that SelectHealth and Intermountain will be responsible for assuring access, service and quality for the enrolled populations. 

To download a SelectHealth Community Care Provider Summary, please CLICK HERE.


If you have questions about SelectHealth Community Care, please contact your Provider Relations Representative at 801-442-3692.

SelectHealth Community Care Provider Panel

IMPORTANT NOTICE:  Providers must be enrolled in one of the following categories with Utah Medicaid in order to be a Community Care panel provider:


  • "Formal enrollment" allows providers to bill Utah State Medicaid for fee-for-service members.

  • "Limited enrollment" is for providers who refer to prescribe but are not reimbursed by the state. This level of enrollment is appropriate for managed care providers who only bill directly to the Medicaid managed care health plan such as SelectHealth Community Care.

If you have questions or concerns, please contact your SelectHealth Provider Representative.


Formal Enrollment as a Utah Medicaid Provider 


http://health.utah.gov/medicaid/provhtml/providerenroll.htm


The set of forms below outline procedures to enroll as a Utah Medicaid provider. For more information, please call Provider Enrollment at 1-801-538-6155, or toll-free 1-800-662-9651 (option 3 then 4).

Providers who wish to enroll as Utah Medicaid providers must fill out each required document in its entirety and mail or fax to the address below. You will be notified of the results of your application.









  • Copy of Professional or Business License (See page 2 of the instructions for completing the provider application, item 2 of this list.)

  • Proof of Medicare Certification (See page 2 of the instructions for completing the provider application, item 2 of this list.) AND one of the following to show current participation:

          -  Current letter of accreditation (JCAHO or AOA)          
          -  Letter from HHS, CMS, or Medicare intermediary showing current enrollment
         
          -  National Supplier Clearinghouse letter with current service address


  • Copy of IRS Form W-9 with current Taxpayer Identification Number
    (See Box 8 on page 2 of the instructions for completing the provider application, item 2 of this list.)

  • Additional Dental Agreement for urban dentists. For questions about the form or the dental program policy, e-mail.

If you are a mental health provider, please fill out the appropriate form below in addition to the above required documents:

 


Mailing Address:


Bureau of Medicaid Operations
Provider Enrollment
P.O. Box 143106
Salt Lake City UT 84114-3106

Fax: (801) 536-0471


Limited Enrollment Provider 

http://health.utah.gov/medicaid/provhtml/providerenroll2.htm

This 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. 

Providers 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. 


  • Utah Medicaid Provider Application(please retain a copy for your records) Please write on top of application whether you are an ordering, referring, or prescribing provider.


  • Copy of Professional or Business License

Mailing Address:


Bureau of Medicaid Operations
Provider Enrollment
P.O. Box 143106
Salt Lake City UT 84114-3106

1-801-538-6155, or toll-free 1-800-662-9651 (option 3 then 4).
Fax: (801) 536-0471


For more information about becoming a provider with the Utah Medicaid Program, please Click here.

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