Orchard - Unchanged

Providers

ATTENTION

PEHP is replacing its claims payment system in phases based on when a member's plan year begins. On July 1, 2025, a large part of our membership will be moved to the new system.

Provider Timeline

How-To Guides & Videos

Need help finding something in the New Provider Portal? Download the Provider User Guide* for step-by-step instructions on:

  • Creating a Provider Account
  • Checking Benefits & Eligibility
  • Submitting & Checking Authorizations
  • Verifying Claim Status
  • Viewing PEHP’s Medical Fee Schedule
  • Accessing Explanation of Payment for Claims

*Note: This guide is for patients with a PEHP ID starting with M0000. For patients with a PEHP ID starting with 174100, please use the Classic Account.

Here's what providers need to know:

  • On July 1, 2025, 90% of our membership will be in the new system. The remainder will transition on September 1, 2025.
  • Since PEHP will be paying claims from two systems until August 31, 2025, make sure to submit claims with the correct ID number (as shown on the PEHP ID card).
    • To verify your patient’s current PEHP ID number, please use the Member ID Lookup Tool available in the Classic Account >> Choose Provider >> Member ID Lookup Tool. Note: You must input the subscriber ID number with no extensions/hyphens to verify eligibility.

How to submit claims:

  • If the member ID number begins with 174100, you need to submit claims using the Classic Account.
  • If the member ID number begins with M0000, you need to submit claims using the New Account.
  • If you submit claims through UHIN or another clearinghouse, you need the correct member ID number (as shown on the PEHP ID card) for the claim to process. If your system requires 13 characters to submit claims, add "00" at the end.

If you have questions, please contact us at (801) 366-7555 or send us a message via the Message Center in the New Account.

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