Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86)

What this rule requires your agency to do

• 1High-categorical-risk billing providers that have not revalidated after July 1, 2025 must complete and submit the mid-cycle revalidation through the PRISM portal within 90 days from the date of the notification letter; failure to do so will result in termination of Utah Medicaid enrollment (26-62 Mid-Cycle Revalidation Scheduled for High-Risk Billing Providers).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 2Effective January 2027, providers of behavioral health residential treatment, partial hospitalization, and intensive outpatient services will be required to submit claims via the 837I (institutional) transaction with the appropriate revenue code (1001, 1002, 0912, 0913, 0905, 0906) and supporting CPT/HCPCS code appended to each revenue code reported (26-74 Behavioral Health Services Revenue Codes).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 3All existing ABA and SUD providers must revalidate their enrollment within the next 18 months and must complete the "High Risk" screening criteria (5%+ ownership disclosure, fingerprint-based criminal background check, unannounced site visits, $750 enrollment fee) within 60 days of the date on their notification letter to avoid closure (26-61 Risk Level Adjustment and Revalidation for ABA and SUD Providers).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 4Parent codes and add-on codes must be billed on the same claim, with the parent code billed sequentially prior to the add-on code; separate and distinct services on the same date of service must be billed with the appropriate modifier (59, XE, XS, XP, XU) and all services must be appropriately documented (26-65 Billing Guidance).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 5Providers billing HCPCS code S8189 for custom silicone tracheostomy tubes are required to submit documentation of the acquisition and shipping costs with their claims; claims will be manually priced at 120% of Actual Acquisition Cost plus shipping (26-75 Policy for Custom Silicone Tracheostomy Tubes).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 6To receive reimbursement for dental services rendered to any Medicaid member, providers must be actively enrolled as Medicaid providers AND enrolled in the University of Utah School of Dentistry (UUSOD) Medicaid Associated Provider Program (26-67 Dental Services for Pregnant, Postpartum, and EPSDT Members).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 7Beginning October 1, 2026, providers will be required to append modifier 93 (audio-only telehealth) or modifier 95 (audio and video telehealth) when providing services via telehealth (26-66 Telehealth Modifiers).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))
• 8Home health services performed for multiple members in the same location shall be billed with the appropriate informational modifier: UN (2 members), UP (3), UQ (4), UR (5), US (6+), per updated Home Health Services provider manual Chapters 8-11.10 and 11-1 (26-83 Multiple Members Served Modifiers).(Medicaid Information Bulletin July 2026 (MIB articles 26-60 through 26-86))