University of Utah Health Plans Fraud and Abuse Reporting Form

Please Note: Only sections one and eight are required. However, it is very helpful to have all sections filled out so we can research the issue(s).

If you need help filling out this form, call us at 801-587-6480 or 1-888-271-5870. (Si necesita ayuda para llenar o completar este formulario, llamenos al 801-587-6480 o 1-888-271-5870). If you are deaf or hard of hearing, you can call Utah Relay Services at 711 or 1-800- 346-4128. Si habla español, puede llamar a Spanish Relay Utah al 1-888-346-3162. These are free public telephone relay services or TTY/TDD. Estos son servicios gratuitos de retransmisión telefónica pública o TTY / TDD.

Member Information
Are you the provider, the member, or a UUHP Customer Service Representative?

Your information (please note, you do not need to provide your name and phone number but it helps us to know who to call if we have additional questions):
Name of member involved if applicable:
Provider Information
Insurance Product
Fraud Information
Upload File
You can fax the information to the Fraud Team at the fax # 801-587-9985.

You may mail the information to:
Fraud Team
6053 Fashion Square Dr., Suite 110
Murray, UT 84107
  
Please note: If you have any additional information, you may mail it to: UUHP, Attn: Fraud and Abuse Officer, 6053 Fashion Square Drive, Suite 110, Murray, UT 84107. You may also contact the Fraud and Abuse officer at 1-888-271-5870.