Medicaid Eligibility Verification

As has always been best practice regarding Medicaid enrollees, remember to verify eligibility prior to every visit. Since Medicaid eligibility can change from month to month, or even during the month, verify eligibility in the month of the visit and no more than 10 days prior to the visit. There are now three methods by which eligibility can be verified:

• PRISM portal (preferred)
• Medicaid Eligibility Lookup Tool
• Phone:
  • Salt Lake City area – 801-538-6155
  • Utah, Idaho, Wyoming, Arizona, Colorado, Nevada, and New Mexico – 800-662-9651
  • From other states – 801-538-6155

SEE A DISCREPANCY BETWEEN PRISM AND PROVIDER PORTAL OR EPIC?

If member enrollment differs between PRISM and Epic or our provider portal, please email uuhpenrollment@hsc.utah.edu. Our team will verify coverage and align records as needed.

Commercial Group and Individual Plans

(Healthy Premier, Healthy Preferred, U Health Plus)

You should always ask for a copy of the member’s insurance card. The insurance card contains pertinent information:

• Member name
• Member ID/subscriber ID
• Date of birth
• Group number (if applicable)
• Payer ID (for 270/271 or EDI)
• Customer service phone number
• Claims submission details

You may verify eligibility using any of the following methods:

• Provider Portal (contracted providers)
• Electronic Eligibility Transactions (270/271 via UHIN): 
  University of Utah Health Plans uses UHIN (Utah Health Information Network) for standard HIPAA‑compliant electronic eligibility checks in real time. 
  Eligibility inquiry: 270
  Eligibility response: 271
• U of U Health Plans Customer Service:
  Call 833‑981‑0213 (toll‑free) to verify eligibility if you’re not contracted or can’t access the provider portal.