Fill in Your Utah 24 06 37 Form

The Utah 24 06 37 form is an essential document for healthcare providers seeking prior authorization for Medicaid services in Utah. This form serves as a request for approval of medical supplies, therapies, imaging, or procedures, ensuring that patients receive necessary treatments covered by Medicaid. It includes critical sections where providers must input details such as the patient's name, date of birth, Medicaid ID, and the specific services being requested. Additionally, the form requires information on the estimated costs, any associated diagnoses, and whether the services of an anesthesiologist or assistant surgeon will be utilized. Providers must also include a summary of the patient's medical history to justify the necessity of the requested services. It is important to note that this form is not applicable for Molina or Healthy U requests, and providers should direct those inquiries to the respective managed care organizations. Proper completion of the form, including all required documentation, is crucial, as incomplete submissions may lead to delays or rejections. For any questions regarding the prior authorization process, providers can reach out to the Utah Medicaid Prior Authorization Unit directly.