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.

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.

Provider Contacts

Idaho

Greg Sonnenberg
Vice President

Lindsey Shelton
Provider Network Specialist

855-447-2900 – Option 6

[email protected]

Montana

Leah Martin
Director

Jill Martin
Provider Network Specialist

855-447-2900 – Option 6

[email protected]

Wyoming

Morris McGaugh
Director

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:
1-801-262-0103
 
Fax outpatient prior authorization requests:
Provider Forms

Provider Update Form

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

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:
801-587-6480 or 888-271-5870
Option 2

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

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
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.

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.” 

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.

Machine Readable Files