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Providers

We Upgraded Our Claims Payment System

As of September 1, 2025, PEHP has completed its transition to a new claims payment system.

All PEHP members now have a new ID number that starts with "M000." New ID cards were issued during each phase of the rollout (Phases 1-4) - not all at once.

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

How to submit claims:

  • You need to submit claims using the New Portal.
  • 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.

Claim Rejected? If your claim is rejected, it’s most likely due to an incorrect ID number. To find out why your claim was rejected, use the EDI Claim Acknowledgement Tool in the Classic Portal. Note: Rejection code 33 indicates an incorrect ID number. To verify your patient’s ID, use the Member ID Lookup Tool in the Classic Portal or contact the patient for the correct ID number.

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

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