Log in or register to:
• View claims, payments, and remittance advices.
• Verify patient’s’ eligibility, benefit overview, and real-time deductible and out-of-pocket maximum amounts.
• Request and review prior authorizations.
BILLING RESPECTIVE CODE SETS
In accordance with the International Classification of Diseases, 10th Revision (ICD-10) and Current Procedural Terminology (CPT) Guidelines for Coding and Reporting, Mountain Health Co-Op will begin to deny claims on April 1st, 2022, when CPT and ICD do not cross match in the respective code set being billed. For accurate reporting of ICD-10/CPT, the documentation should describe the patient’s condition, services as well as symptoms, problems, and reasons for the encounter. Coding to the highest level of specificity is required when supported by the medical record and to support medical necessity.
For assistance:
877-814-9909
[email protected]
Greg Sonnenberg
Vice President
Lindsey Shelton
Provider Network Specialist
855-447-2900 – Option 6
Leah Martin
Assistant Vice President
Jill Martin
Provider Network Specialist
Taetumn Bailey
Provider Network Specialist
855-447-2900 – Option 6
Morris McGaugh
Director
Lindsey Shelton
Provider Network Specialist
855-447-2900 – Option 6
Patient eligibility and benefits:
1-844-262-1560
Prior authorizations for medical services:
1-801-587-2851
855‐885‐7695
801-213-2132
Use this form, along with missing documentation, for MDOC claim denials.
Use this form to add a new provider to your already contracted group, or to notify the CO-OP about a name or address change.
Use this form to remove a provider that has left the group.
Please complete page 2 of this form to add a new location or change a location address.
Claims Submission
Claims should be submitted through our plan administrator’s clearinghouse, the Utah Health Information Network (UHIN).
Submitting Additional Documentation
For submitting additional documentation, please use the Medical Documentation Submission Form.
Receiving Funds
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.
- Services Requiring Prior Authorization
-
Medical Electronic Request Form
(PREFERRED METHOD) -
PDF Prior Authorization Form
(suitable for faxing) - Skilled Nursing Facility & Acute Rehab Request Form
- Home Health Care Request Form
- Hospice Care Request Form
- Behavioral Health/Substance Request Form
- MRI Criteria Guidelines
Utilization Mgmt. Medical Policies
We would be happy to provide you with a copy of the criteria we use to make utilization management decisions.
Contact the UM team for more info: 855-447-2900
You may also email your request for criteria to [email protected]
Provider Manual
Provider Policies
Mountain Health CO-OP has contracted with the University of Utah Health Plans to both process claims and oversees our care and utilization management programs.
Through these programs, care and utilization management teams assist members in obtaining the right care at the right time. Through their work, these teams help our members achieve the best outcome, using nationally-recognized, evidence-based guidelines.
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]
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.”