How to become a Medicaid provider in Utah
To bill Utah Medicaid, enroll through PRISM Provider Portal. The process has 6 steps, listed below with the documents the state asks for.
- Enrollment portal
- PRISM Provider Portal
- Steps
- 6
- Documents
- 5
- Plans listed
- 4
On this page
Utah Medicaid enrollment at a glance
To bill Utah Medicaid, enroll through PRISM Provider Portal. The process has 6 steps, listed below with the documents the state asks for.
- Program
- Utah Medicaid (Utah Department of Health and Human Services, DHHS)
- Enrollment portal
- PRISM Provider Portal
- Application fee
- Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Utah DHHS's enrollment pages do not list a separate state fee.
- Fingerprinting
- Under federal rules (42 CFR 455.434 and 455.450), the state places provider types in 'limited', 'moderate' or 'high' risk levels. High-risk providers, and anyone who owns 5% or more of one, must submit fingerprints for a criminal background check. Utah DHHS's enrollment pages do not describe a separate state fingerprint process.
- Site visit
- Under federal rule (42 CFR 455.432), the state must visit moderate- and high-risk providers before and after enrollment. Every enrolled provider must allow unannounced on-site inspections. Utah DHHS's enrollment pages do not describe a separate state site visit process.
- Revalidation
- Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. Utah DHHS's become-a-provider page does not describe a separate state revalidation cycle.
- Provider manual
- Provider manual
Steps
- Create a Utah-ID account and set up multi-factor authentication
- Start the new enrollment application in the PRISM portal; incomplete online applications are purged after 90 days
- Use the 'Enrolling as a New Medicaid Provider' eLearning course for your enrollment type
- Send supporting documents (provider name and NPI on each) by fax to 801-536-0471 or 801-323-1574 if not uploaded
- Track the application in PRISM
- To serve ACO members, contract with each managed care plan
Documents the state asks for
Joining managed-care plan networks
- Credentialing
- Members in 13 urban counties must choose a managed care plan (ACO); members elsewhere can choose a plan or stay fee-for-service. Behavioral health runs through Prepaid Mental Health Plans, and adult expansion members in five counties use Utah Medicaid Integrated Care (UMIC) plans. Providers enroll with Utah Medicaid in PRISM and contract with each plan separately. DHHS pages describe no centralized credentialing.
- Plans (state list)
- Health Choice Utah
- Healthy U
- Molina Healthcare
- SelectHealth Community Care
Frequently asked questions
How do I become a Medicaid provider in Utah?
To bill Utah Medicaid, enroll through PRISM Provider Portal. The process has 6 steps, listed below with the documents the state asks for.
Is there an application fee to enroll in Utah Medicaid?
Under the federal rule (42 CFR 455.460), institutional providers pay the CMS application fee when they first enroll, re-enroll or revalidate. The fee is $750 for calendar year 2026. Individual physicians and non-physician practitioners do not pay it. A fee already paid to Medicare or to another state's Medicaid program counts. Utah DHHS's enrollment pages do not list a separate state fee.
How often must Utah Medicaid providers revalidate?
Federal rule (42 CFR 455.414) requires the state to revalidate every enrolled provider at least once every 5 years. Utah DHHS's become-a-provider page does not describe a separate state revalidation cycle.