Orchard - Unchanged

Providers

These one-page tip sheets give you an overview of what you need to know about treating PEHP patients.

Provider Basics PDF file


Know Your Networks

We've heard that provider offices enter PEHP member information in their system as the patient having “PEHP.” We have four different networks, so it’s crucial that your staff enrolls our members with the specific network they have. Some benefits of ensuring accuracy in the setup:

  • Avoiding denials if your provider is not in-network with the specific network.
  • Assists our members in knowing if your provider is in their network before setting up an appointment.
  • Providing satisfaction to our members, knowing they are being referred to specialists, facilities etc. in their network.

For your convenience, copies of the cards can be located in the Provider Library section of the provider website too. Additionally, providers can access our Provider Directory tool in the secure provider portal to identify in-network providers for referrals.

Access Provider Directory

COVID-19 Update
PEHP values the work being done by our healthcare partners during the COVID19 pandemic. In an effort to better assist you during this time, please note the following:

Prescription Authorizations
All prescription medication authorizations scheduled to expire in the next 90 days have been extended by 90 days from the date they were set to expire. Only new therapy will require contacting PEHP for preauthorization.

Telehealth/E-Care Benefit
We want to remind you that PEHP contracts with Intermountain Healthcare’s Connect Care telehealth solution for all our networks as well as with the University of Utah’s Virtual Visit telehealth solution for our Summit, Preferred, & Capital Networks. PEHP covers telehealth visits provided by any of our contracted providers at a rate of 90% of the in-office fee. Telehealth services should be provided with a HIPAA compliant platform and billed with a GT modifier or 02 place of service.

Telephone Visits
PEHP will be covering the telephone E & M visit codes (99441-99443) now through the coronavirus crisis to assist our members to have access to provides that may not have a telehealth option to communicate with our members.

Interacting with PEHP
In response to federal, state, local government, and health officials' directions and recommendations, PEHP has implemented a remote work program. This may require that some communications to and from PEHP be electronic as we make this transition, but we do not expect any delays in claims processing or accessing benefits information.

As the situation around COVID-19 continues to develop, we'll post updates here to keep you informed of future changes to our operations.

Again, we thank you for the wonderful care you are providing our members.