This EFT request form authorizes University of Utah Health Plans to deposit funds for claims payment directly into a vendor's bank account.
This request form also allows for reversal of payments that were made in error.
This authority is to remain in full force and effect until University of Utah Health Plans has received written notification from the vendor of its termination in such time and manner as to afford University of Utah Health Plans a reasonable opportunity to act on it.
EDI participation is not an indication of contracting status. To verify contracting status, please contact customer service at (801) 587-6480.
EDI Department, University of Utah Health Plans. Fax: 801-281-6121, Email: firstname.lastname@example.org
Please email a W9 if you have never submitted a claim to UUHP.