Update Demographics (contact information, addresses or email), Report new portal account creation error, or Adding non-contracted provider for claim submission
Please complete the Provider Account Information form and return to PEHP via email: providersubmissions@pehp.org or the Message Center in the New Provider Portal box "Form Submission for Demographic Add, Change, Delete"
Add/Remove a Single Provider from Existing Group Contract (i.e. hospital or clinic)
Please complete the Add/Remove Provider - Current Provider Contract form and return to PEHP via email: providersubmissions@pehp.org or the Message Center in the New Provider Portal.
Add/Remove Multiple Providers from Existing Group Contract via Roster Submission
Please complete the roster form and return to PEHP via email: providersubmissions@pehp.org or the Message Center in the New Provider Portal. Note: NPI number required on all changes.
Validate That a Provider has been Added
Log on using your Local Administrator role, and go to Resources->Reports->Provider Report. When running the report, select the practice location and hit enter. It loads the current list of practitioners enrolled at that location.
New Applications
PEHP has an open provider panel and welcomes new applications from individual providers and groups. To join a PEHP network, fill out the appropriate form below and send to providersubmissions@pehp.org.
INDIVIDUAL PROVIDERS
GROUP PROVIDERS (This is the appropriate form for all Individual and Group Medical and Dental Providers)
PEHP Credentialing Policies
Providers who contract with PEHP must meet PEHP credentialing requirements. This is true for any individual provider or for group providers who submit a new application and for any provider that is added to an existing group contract. If an individual provider or group fails to keep PEHP informed of any provider’s license restrictions, fails to inform PEHP of any provider actions which may jeopardize the health and safety of PEHP members, or falsely states that the provider is in compliance with PEHP credentialing requirements, the network contract with PEHP shall be immediately terminated, and the provider or group may be subject to applicable civil and criminal penalties.
Terminate Contract
Please submit a notice of termination at least 30 days prior, as outlined in section 4.3 of the contract.
Written Notice: PEHP Provider Contracting, 560 E 200 S, Salt Lake City, UT 84102
Email: providersubmissions@pehp.org
Message Center: Secure Message Center in New Portal
Questions?
If you have issues validating from the report, or questions about status of a form, send a message in the New Provider Portal to "Questions: web, form status and general" or call the Member and Provider Service Center at 801-366-7555 and select "benefits" to reach a customer service agent who can assist. We will not reposnd to any request sent to providersubmissions@pehp.org or the message center "Form Submissions Demographic Add, Change, Delete."