Providers Outside of Utah or Not Contracted with PEHP

For claims to pay, you must be set up in PEHP’s system and you must submit your claims electronically.

To be set up in our system, complete the Provider Account Information form and return it via email to providersubmissions@pehp.org. Please allow at least 10 business days to process the form before you submit claims for payment.

Electronic Claim Submission Options

• Using a Clearinghouse: Submit your claims electronically through the clearinghouse of your choice via our gateway, UHIN. No Clearinghouse? Visit UHIN.org to submit individual claims electronically at low rates.

• PEHP Provider Portal: Submit individual professional and dental claims directly via the PEHP Provider Portal. (Account set up required, see instructions below).

If a claim rejects, please double check to make sure all fields have been properly filled out.

PEHP Provider Portal

Once you’ve been added to our system, you can create an online provider portal account to access pre-authorization forms, check member eligibility & benefits, view claims status, and receive electronic payments.

To get started, create an account here: PEHP Provider Portal

Important Notes:

• New Provider Portal: The first person to log in becomes the administrator responsible for creating all other provider accounts. Both professional and dental claims may be submitted through the New Portal.

• Classic Provider Portal: The contact person listed on the Provider Account Information form will be set up as the administrator, who can then create other provider accounts. Only professional claims may be submitted through the Classic Portal.

On the portal you can sign up for new EFT enrollment and make changes to your current EFT enrollment. If you have any questions, please call our EDI Department at 801-366-7544 or 800-753-7818.

You must follow PEHP’s clinical policies, including medical pre-authorization, to be eligible for payment.

ALL OUT-OF-STATE HOSPITAL SERVICES REQUIRE PREAUTHORIZATION.

Learn more about Medical Preauthorization

Important Information:

• Not all PEHP members have an out-of-network benefit because the availability of this benefit varies by employer.

• PEHP pays less to out-of-network providers than it does to in-network providers for non-emergency services. Learn more about contracting with PEHP

• PEHP will deny payment for services from an out-of-network provider if the provider or the services they provide are listed on the Non-Covered Provider List

• PEHP accesses out-of-state services through MultiPlan. PEHP reserves the right to not process a claim through MultiPlan if the provider is not on PEHP’s approved provider list