Indicate the networks with which you are interested in participating:
Note: This application does not apply to the Huntsman Mental Health Behavioral Health Network (HMHI BHN). If you are interested in becoming a participating provider with HMHI BHN, please contact Jessie.Konate@hsc.utah.edu.
Completion of this application does not guarantee a contract or participation with University of Utah Health Plans.
Completely describe your services or scope of practice in the space below and/or attach any relevant marketing materials describing your services.
This information is for the person we should contact if there are any issues with the application.
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Service Location Features
Select all that apply
Accessible Medical Equipment
You'll need to fill out a provider section for each provider or upload your complete provider roster for those who sees patients.
If submitting a roster, please include the following for each provider:
Provider agrees University of Utah Health Plans may share provider application and related credentialing information with any group or entity that has delegated or contracted with U of U Health Plans to provide such activities on their behalf. Information cannot be shared for any reason except for provider directory/demographic and credentialing activities.
U of U Health Plans does not discriminate based on race, gender, nationality, age, sexual orientation, the type/cost of treatment or patient in which the provider specializes including providers serving high-risk populations, or in terms of participation, reimbursement, or indemnification, against any health care professional who is acting within the scope of his, her or their license or certification under state law, solely on the basis of the license or certification.
Are you sure you wish to delete this provider?
Are you sure you wish to delete this location?
Do you travel to see patients? If not, please answer no to this question.
It looks like one or more of the locations have answered yes for being handicap accessible, but no service location features or accessible medical equipment were selected. Do you wish to make some selections or update the response to being handicap accessible to no?
One or more providers are missing a CAQH number. You can register for a CAQH number here. Once the CAQH application has been completed, make sure University of Utah Health Plans has been granted access to the application.
A provider section must be completed for each individual provider.
To include EMDR as an area of interest in one or more of our provider directories, we will need this EMDR Affidavit completed by the practitioner and returned with your provider application.