provider giving young patient a high-five

Provider Relations

provider giving young patient a high-five

Provider Relations

Provider Relations

  • Provider Relations

    provider.relations@hsc.utah.edu
    801-587-2838 option 2

    • Escalated provider issues
    • Provider contracting questions
    • Claims concerns not addressed by Customer Service

     

  • Emily Bird, Provider Consultant

    emily.bird@hsc.utah.edu

    801-587-2666

    Provider Consultant Map

    Salt Lake County in Utah and all Nevada:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • Pathology labs
    • Dialysis centers
    • Holy Cross Hospitals
    • Holy Cross Medical Group

  • Sandra Campbell, Provider Consultant

    Sandra.campbell@hsc.utah.edu

    801-587-2943

    Provider Consultant Map

    Beaver, Carbon, Emery, Garfield, Grand, Iron, Juab, Kane, Millard, Piute, San Juan, Sanpete, Sevier, Utah, Washington, and Wayne counties in Utah; and all Colorado and Wyoming:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • HCA physicians
    • Anesthesia Groups
    • HCA MountainStar Hospital System
    • Durable Medical Equipment companies

  • Mary Carbaugh, Provider Consultant

    Mary.carbaugh@hsc.utah.edu

    801-587-2920

    Provider Consultant Map

    Box Elder, Cache, Daggett, Davis, Duchesne, Rich, Morgan, Summit, Tooele, Uintah, Wasatch, and Weber counties in Utah; and all Idaho:

    • Physicians, practitioners, physical therapy providers, chiropractors, behavioral health providers, audiologists, podiatrists, optometrists, dentists; independent hospitals, and ambulatory surgical centers

    Throughout Utah:

    • Interpreting Agencies
    • Intermountain Healthcare
    • Skilled Nursing Facilities
    • Home Health, and Hospice
    • Long-Term Acute Care hospitals

Provider Information Update Form

Please include any associated provider(s) and NPI(s) number(s) that we need to have listed under the change. If needed, attach a provider roster, W-9, or other necessary documentation below. This information is required to complete this request.

Anything with a * next to it is a required field.

CONTACT INFORMATION

EXISTING ADDRESS
EXISTING BILLING ADDRESS

PRACTICE INFORMATION

* ASSOCIATED PROVIDER: (IF MULTIPLE PROVIDERS, ATTACH INFORMATION AS A SPREADSHEET OR OTHER FORM OF ROSTER BEFORE SUBMITTING THIS FORM.)
NEW PRACTICE ADDRESS
(PICK ALL THAT APPLY)
Website URL: By providing the URL to your clinic website, you give University of Utah Health Plans permission to publish a link to your site in our provider directories. U of U Health Plans assumes no responsibility or liability for the information displayed on your site.
NEW BILLING ADDRESS

Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: pdf, doc, docx, ppt, pptx, xls, xlsx, xml, zip.