Provider Education Opportunity

Discover Who We Are

Want to know more about who we are and what we do at Mountain Health CO-OP? Existing and future participating providers are welcome to join us. 

What we will be covering

Reserve Now

Register now for a seat at the opportunity nearest to you! Seating is limited, so reserve your place today.

Gillette, WY

Tuesday, September 19
10:00 Am

Sheridan, WY

Wednesday, September 20
10:00 Am

Rock Springs, WY

Wednesday, September 27
10:00 Am

Jackson, WY

Wednesday, September 28
10:00 – 11:30Am CDT

Claims

Forms For Providers

Claims Submission

Claims should be submitted through our plan administrator’s clearinghouse, the Utah Health Information Network (UHIN). More details: http://www.uhin.org/

Forms For Providers

Receiving Funds & Setting up EFT

We must have a W-9 on file before we can make any payments to you. You can fax your W-9 form to 801-281-6121. If we do not have a direct deposit set up for your group, we will send a paper check.

Forms For Providers

Submitting Additional Documentation

For submitting additional documentation, please use the Medical Documentation Submission Form.

Search All Provider Forms & Documents

Search by Document Name

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Forms For Providers

Appeal Form

Behavioral Health Provider Policies

Residential Treatment Center (RTC) Requirements Policy

Forms For Providers

Behavioral Health/Substance Request Form

Forms For Providers

Claims Submission

Claims should be submitted through our plan administrator’s clearinghouse, the Utah Health Information Network (UHIN). More details: http://www.uhin.org/

Forms For Providers

Consent Form

Forms For Providers

Formulary Exception Request Form

Suitable for faxing

Forms For Providers

Home Health Care Request Form

For a better experience, complete your request here Or you may fax your request: 801-213-1358. Please include this document at the front of your submission.

Forms For Providers

Hospice Care Request Form

Forms For Providers

Location Add/Change Form

Use this form to add a location, change location, and change billing information.

One Moment...

Join our Provider Network 

Being a Co-Op Provider
As a non-profit, member-owned health insurance CO-OP, we are dedicated to ensuring access to quality cost-effective health insurance for our communities.

We offer an array of benefit plans that will fit your patient’s individual needs.

We believe doctors and hospitals should be fairly compensated for the work they perform.

Questions?
[email protected]

Complete form to receive contract documents.

Provider Newsletters

Summer 2023

Details about our latest updates, telehealth, and Medicaid unwinding.

Spring 2023

Details about important updates. 

Winter 2022

Now that 2022 is behind us, this is an excellent time to review patient records to ensure everyone is current with their annual preventive visits for 2023.

Fall 2022

We’re pleased to announce the successful launch of the new, secure Mountain Heal CO-OP Provider Portal.

Summer 2022

The Federal No Surprises Act went into effect January 1, 2022, bringing new requirements for health plans and providers. 

Spring 2022

In recent years, suicide rates have continued to rise. This topic needs to be continually talked about to bring more education around suicide prevention.

Fall 2021

Mountain Health CO-OP, in collaboration with University of Utah Health Plans (UUHP), has been in the process of creating a new secure portal to replace the current LINK Provider Portal.

Summer 2021

The CO-OP is excited to share our new website. This website has been built to create an
easier user experience for our members, providers, and brokers. The website is easier to navigate, with updated information, a user-friendly.

Winter 2021

According to the July 16, 2020 NCQA blog, “Kidney disease affects 37 million American adults, but 90% are unaware they even have it.” 

Provider Contacts

Idaho

Greg Sonnenberg
Vice President

Lindsey Shelton
Provider Network Specialist

855-447-2900 – Option 6

[email protected]

Montana

Leah Martin
Assistant Vice President

Jill Martin
Provider Network Specialist

Taetumn Bailey
Provider Network Specialist

Tasha Harris
Provider Network Specialist

855-447-2900 – Option 6

[email protected]

Wyoming

Morris McGaugh
Director

Lindsey Shelton
Provider Network Specialist

855-447-2900 – Option 6

[email protected]

General

Patient eligibility and benefits:
1-844-262-1560

Prior authorizations for medical services:
1-801-587-2851

Prior authorizations for prescription drugs:
855‐885‐7695
 
Fax inpatient notifications:
801-213-2132
 
Fax outpatient prior authorization requests:

Machine Readable Files