PEHP currently supports the following transactions:
- 837: Health Care Claim – PEHP accepts dental, professional and institutional claims. PEHP will return a Functional Acknowledgment (999) report and a Front End Acknowledgment (277CA) report.
- 270/271: Health Care Eligibility and Benefit Inquiry – Real time or batch eligibility and benefit requests. Currently available through the UHINT tool, may also be available through your practice management system or clearinghouse.
- 276/277: Health Care Claim Status Inquiry – Real time or batch status reports on claims that were previously submitted. Currently available through the UHINT tool, may also be available through your practice management system or clearinghouse.
- 277CA: Unsolicited Claim Status – PEHP will send a front end claim status response for each claim sent. This response will tell you which of your claims were accepted into our adjudication system. If the claim is rejected, the response will give you the appropriate code for why the claim was rejected.
- 835: Health Care Claim Payment and Remittance Advice – Providers have the option of receiving an electronic remittance, either directly through UHIN, their clearinghouse or by downloading and viewing the remittance from our website. Any of these options allow providers to enroll for electronic funds transfer (EFT).
- Electronic Funds Transfer (EFT) – PEHP will transfer funds to the provider's bank and send an electronic remittance (835) to the provider through their clearinghouse/UHIN or the provider can log on to www.pehp.org and download a PDF file of their remittance advice.