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A contracted provider has the responsibility to file the claim within 12 months from the date of service. Claims denied for untimely filing are not the member’s responsibility, unless one of the … more
A contracted provider has the responsibility to file the claim within 12 months from the date of service. Claims denied for untimely filing are not the member’s responsibility, unless one of the … more
PEHP offers affordable Life and Accident insurance plans you can count on.
Get the coverage you need to ensure your loved-ones will be financially secure in the event of your death or … more
Clear Claim Connection is a web-based tool by McKesson Health Solutions that lets providers review PEHP’s claim auditing rules and the clinical rationale behind them. It offers easy access to claims … more
A primary care doctor can help with short-term problems and take care of you over time, making them a crucial partner for your health. Here are five reasons why having a primary care doctor matters: … more
HEALTH INSURANCE BASICS
Plan vs Network
Your plan outlines your medical coverage, and your network determines which doctors, clinics, and hospitals you visit for in-network healthcare. Make … more
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 … more
CGM, Insulin, Test Strips, and GLP-1 Drugs
$0 for Continuous Glucose Monitor (CGM)*
You can get a Continuous Glucose Monitor (CGM) at No Cost. Just ask your doctor to switch your … more
New claim editing software effective July 1, 2026
As part of the implementation of our new claims payment system, PEHP is also updating the software used in its claims editing application. … more
A remittance advice/EOP details how your claim was processed. PEHP offers three convenient ways to obtain it:
Electronic (835)
Sent electronically after claim adjudication.
Benefits: … more