Utah Medicaid will be making substantial changes to the provider manuals. Medicaid will start moving policy from the provider manuals to the appropriate Utah Administrative Rule within R414, Health, Health Care Financing, Coverage and Reimbursement Policy. Providers will notice this move taking place over the next several quarters. Moving Medicaid policy to the Administrative Rules will allow providers the opportunity to review and comment on rule updates. Providers are encouraged to become familiar with the Administrative Rule, because Medicaid coverage policy will be relocated to the appropriate rule based on service coverage.
The manuals will also be streamlined. For example, ancillary services such as laboratory services and women’s services information will be in the Utah Medicaid Physician Services Provider Manual effective July 1, 2017. As part of the manual revision process, information regarding specific code coverage will be moved from the provider manuals to the Utah Medicaid Coverage and Reimbursement Lookup Tool. The provider manuals will continue to be a reference for criteria and reporting instructions. Providers are encouraged to become familiar with the updated rules and manuals noting changes in the structure, formatting, and content of the manuals. Providers are still required to follow coverage policy, criteria, and prior authorization (PA) requirements.
View the updated provider manuals here: https://medicaid.utah.gov/utah-medicaid-official-publications
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