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    • Common Types of Fraud
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    • Get Preauthorization to Get your Full Benefit
    • Top 10 Costly Coverage Traps
    • Save Big Money
    • How to Use Cost Saving Tools
 
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PROUDLY SERVING UTAH
PUBLIC EMPLOYEES

Trust • Commitment • Value • Innovation • Excellence

General

PEHP is a non-profit trust with the vital job of providing health benefits to Utah's public employees

  • About Us
    • About Us
    • PEHP Administrative Staff
    • Health Alert
  • Find a Provider
    • Find a Provider
  • Feedback: Send email to PEHP
    • Feedback: Send email to PEHP
  • Legal Notice and Disclaimer
    • Legal Notice and Disclaimer
  • Contact Information
    • Contact Information
  • Fraud and Abuse
    • How to Report Fraud
    • Frequently Asked Questions
    • Common Types of Fraud
    • How PEHP is Fighting Fraud
  • Cost And Quality Tools
    • Cost-Saving Tips
    • Get Preauthorization to Get your Full Benefit
    • Top 10 Costly Coverage Traps
    • Save Big Money
    • How to Use Cost Saving Tools

Frequently Asked Questions

My PEHP member identification card was lost or stolen. What should I do?

If your member card is lost or stolen, you should immediately contact PEHP to prevent payment of services to any unauthorized person.

I received an explanation of benefits for services I didn’t receive. Is this fraud

Billing for services not rendered is one of the most common types of fraud committed by providers. However there are instances when a provider mistakenly submits a claim with an incorrect identification number, causing payment to be issued under the wrong patient. Always report erroneous charges; PEHP's SIU will thoroughly research the charges and determine whether it is fraud or simply a billing error.

I'm newly divorced. Is it Okay to keep my ex-spouse on my coverage?

Once your divorce is final, coverage terminates at midnight on the day prior to your divorce date. The divorced spouse is no longer a dependent and if he/she continues using your benefits, you are responsible for any payments made erroneously. You may also not enroll or continue to cover an ineligible dependent (e.g., married child) on your plan.

My doctor billed my health plan for an office visit when all I did was pick up a prescription. I never saw my doctor. Can he charge for this?

No, this is considered billing for services not provided and should be reported to PEHP immediately.

I think my doctor may be billing fraudulent charges. If I report this and you later confirm that no fraud was committed, will my provider know I reported him?

Never be afraid to report a doctor for suspicion of fraudulent billing or inappropriate behavior. You are not required to identify yourself when reporting fraud. PEHP takes every complaint seriously and is committed to protecting your confidentiality. Remember, if the provider is filing fraudulent charges regarding you then he/she may be filing wrongful charges under other patients’ coverage as well.

What are the most common types of provider fraud?

  • Billing for services not provided
  • Double billing
  • Billing for services performed by non-licensed or ineligible providers
  • "Unbundling" or billing separately for component parts of a medical procedure
  • "Up coding" or billing for a higher level of service than was performed
  • Billing for services originally advertised as "free"
  • Overutilization of services
  • Billing non-covered services as covered services
  • Billing under another family member when maximum benefits have been paid on the actual patient
  • Prescribing, then offering to buy back, powerful narcotics after the insurance has paid for the prescription

PEHP Healthy Utah

Access PEHP Healthy Utah. Make sure you and your spouse create your individual PEHP for Members accounts at www.pehp.org to schedule your testing session, see results, and to apply for rebates. Learn more

On-Demand Doctors

Intermountain Connect Care offers convenience and savings to all PEHP members with live, on-demand doctor visits online or by phone.

 

Get Fit, Get Paid

Check out our wellness tools and programs. See how you can earn cash rewards for improving your health.

Compare Pricing Among Doctors and Hospitals

Searching for providers? Now you can see and compare pricing based on your benefits. Learn more about Cost & Quality Tools

Get Fit, Get Paid

Check out our wellness tools and programs. See how you can earn cash rewards for improving your health.

Compare Pricing Among Doctors and Hospitals

Searching for providers? Now you can see and compare pricing based on your benefits. Learn more about Cost & Quality Tools


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