Submitting Claims Electronically

To receive payment, providers must be setup in PEHP's system and submit claims electronically.

Get Set Up

Complete the Provider Account Information form and email it to providersubmissions@pehp.org.
Allow 10 business days for processing before submitting claims.

How to Submit Claims

• Via Clearinghouse: Utah Health Information Network (UHIN) provides a private and secure gateway for electronic data exchanges. You can set up an account with UHIN or just send individual claims through its portal for a nominal monthly fee. If you have a preferred clearinghouse, just ask them to submit your claims electronically to PEHP via UHIN. Learn more at www.uhin.org.
• Once you establish an account with UHIN, please contact our EDI department at 801-366-7544 to be setup in our system for testing.

OR

• PEHP Provider Portal (Account setup required): Submit individual claims directly. See how.

> If a claim is rejected, check that all fields are complete and accurate.

PEHP Provider Portal Access

To access the PEHP Provider Portal, you need to be setup in our system. Complete the Provider Account Information form and email it to  providersubmissions@pehp.org.
Allow 10 business days for processing before submitting claims.

Once registered, create a portal account to:

• Submit claims. See how.
• Check eligibility & benefits
• View claim status
• Enroll/update EFT (required for payment)

> First login = portal administrator.
> Questions? Call 801-366-7544.

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