Providers

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.


Provider Education Opportunity

Want to know more about who we are and what we do at Mountain Health CO-OP? Join us in person in Wyoming for one of four opportunities to get to know us.

Existing and future participating providers are welcome to join us. We will be covering…

  • Who We Are
  • Available Provider Tools
  • Prior Authorization Resources
  • New Provider Portal
  • And More

Click here to register for the event in Cody, Wyoming – July 11, 10 a.m. – 12 p.m.

Click here to register for the event in Buffalo, Wyoming – July 12, 10 a.m. – 12 p.m.

Click here to register for the event in Casper, Wyoming – July 13, 10 a.m. – 12 p.m.

Click here to register for the event in Cheyenne, Wyoming – August 1, 2 p.m. – 4 p.m.

Email [email protected] with any questions.

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]

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]

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:
Provider Forms

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

Claims Submission

Claims should be submitted through our plan administrator’s clearinghouse, the Utah Health Information Network (UHIN).

Visit the website for more information.

How to Submit Claims

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.

How to set up EFT

Appeals

For questions about appeals:
1-844-262-1560

 
Preauthorizations
Policies

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

This manual is where you can look for policies and procedures.

PDF Manual

Word Doc 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.

Access Medical Policies

Behavioral Health Policies

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]

 

Join Our Network

Newsletters
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.” 

Machine Readable Files

Cultural Competency & Language Resources

Providers are trusted with rendering care to a diverse membership with different levels of health literacy and confidence in the healthcare system, as well as racial, ethnic, and religious backgrounds that inform behaviors and choices about healthcare.

The Co-Op is committed to supporting providers in ensuring members receive culturally competent and linguistically appropriate care.

Additionally, the Co-Op service territory is home to thirteen Native American Reservations across Montana, Idaho, and Wyoming, and twenty-two federally recognized tribes.

Providers are encouraged to familiarize themselves with the resources below: