Provider Basics
These one-page tip sheets give you an overview of what you need to know about treating PEHP patients.
PROVIDER TIPS » Cardiology
Preauthorization
General information
- See this list
of services that require preauthorization. - To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children's Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Specialty information
- CCTA requires preauthorization. PEHP does not cover calcium scoring.
- Life Vests (only provided by Zoll) are paid at the in-network benefit, but member may be balance billed. This provider will not contract with PEHP.
- All genetic/molecular diagnostic tests require preauthorization.
Affordable Care Act (ACA)
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
Prescription Drugs
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Exclusions
See complete list of exclusions.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children's Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Speciality information
- PEHP pays non-contracted Holter monitoring as a hidden provider; the member may be balance billed.
Labs and Imaging
General information
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Specialty information
Genetic testing for predisposition to hypertrophic cardiomyopathy (HCM) is considered medically necessary for individuals who are at risk for development of HCM, defined as having a first-degree relative (e.g., siblings, parents, and offspring) with established HCM, only when there is a known pathogenic gene mutation present in that affected relative.
PEHP does not cover genetic testing for Brugada syndrome.
09/16/16
PROVIDER TIPS » Gastroenterology
Preauthorization
General information
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Speciality information
See pharmacy and lab information on next page.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Exclusions
See complete list of exclusions.
Affordable Care Act (ACA)
General information
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table. Medically indicated colon screening performed under the age of 45 is paid under regular benefits,
Specialty information
The use of general anesthesia for endoscopy must be medically necessary and requires preauthorization if the patient is between the age of 18 thru 69. For preauthorization criteria, please see Anesthesia Services for Gastrointestinal Endoscopic Procedures. If the patient is under 18 or over age 70, general anesthesia does not require pre-authorization.
Prescription Drugs
General information
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Specialty information
Crohn’s Disease » PEHP requires a trial and failure to 1 conventional therapy (if the disease is severe or fistulizing and TNF therapy is recommended first line, please send appropriate documentation). PEHP preferred agents (Remicade, Cimzia, Enyvio)at Tier A $150 max copayment.
Humira is covered after failure of the above agents at a tier C (20%) benefit Cimzia and Entyvio are available through Accredo.
Ulcerative Colitis » PEHP requires a trial and failure to 1 conventional therapy. PEHP preferred agents are Remicade and Entyvio.
Humira and Simponi are not covered.
Labs and Imaging
General information
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Specialty information
All genetic tests require preauthorization. Complete medical necessity policies (such as celiac disease, colon cancer, IBD, and hereditary pancreatitis ) are available at PEHP for Providers. Tests performed at Prometheus Laboratory will not be reimbursed by PEHP.
02/21/17
PROVIDER TIPS » Ophthalmology
Preauthorization
General information
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Specialty information
- Amniotic membranes and intra-corneal rings require preauthorization.
- In all instances, extended ophthalmologic tests or screening (92283, 92284) must be medically necessary. To establish medical necessity, a serious ophthalmologic condition must exist, or be suspected, based on routine ophthalmological tests and require further detailed study.
- Vision therapy ( 92065) is covered for convergence insufficiency and requires preauthorization.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Affordable Care Act (ACA)
General information
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
Prescription Drugs
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Labs and Imaging
General information
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
September 2016
PROVIDER TIPS » Orthopedic
Preauthorization
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Speciality information
Bone grafts and skin grafts require preauthorization. Total ankle replacement requires PA. PEHP does not cover subtalar implants.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient's care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Affordable Care Act (ACA)
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
Prescription Drugs
General information
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Specialty information
Post-op pain management » Because of safety and efficacy concerns, PEHP limits high-dose opioids (≥ 150 MED) to pain management physicians. PEHP requires preauthorization on all longacting opioids, with the exception of morphine sulfate ER (MS Contin) and Nucynta ER. However, after surgery patients can fill up to three months of Oxycontin without a preauthorization. If a patient has a need for long-term, high-dose opioids following surgery, PEHP can help to arrange a pain management consultation with our preferred pain providers. Please contact us at 888-366-7551 for additional questions.
Labs and Imaging
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
See complete list of exclusions.
09/16/16
September 2016
PROVIDER TIPS » Physical Medicine
Preauthorization
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Speciality information
- Neurolysis (64640) requires preauthorization.
- PEHP allows up to 20 PT visits without preauthorization. The physical therapy benefit is capped at 20 visits per plan year.
- Spinal cord stimulators require preauthotization.
- PEHP does not cover trigger point injections, greater or lesser occipital nerve blocks, or radiofrequency for migraine headaches.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient's care is not just contracted with PEHP but is specifically part of the members network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Prescription Drugs
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Labs and Imaging
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
See complete list of exclusions.
Affordable Care Act (ACA)
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
09/22/16
September 2016
PROVIDER TIPS » Podiatry
Preauthorization
General information
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Speciality information
- Skin substitutes require preauthorization.
- Chemical neurolysis for Morton's neuroma and plantar fasciitis are considered investigational.
- PEHP considers platelet-rich plasma and/or stem cells, alone or in conjunction with treatment of plantar fasciitis, experimental.
- Metatarsal or tarsometatarsal arthodesis requires preauthorization.
- Implants for hammer toe surgery are considered investigational and not covered.
- Subtalar implants require authorization.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Prescription Drugs
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Labs and Imaging
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
See complete list of exclusions.
Affordable Care Act (ACA)
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
08/31/16
September 2016
PROVIDER TIPS » Primary Care
Preauthorization
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Prescription Drugs
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Affordable Care Act (ACA)
General information
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
Specialty information
With colon screening, patients who meet the criteria for both MAC (anesthesia services for gastrointestinal endoscopic procedure available at www.pehp.org) and the preventative screening guidelines will have the MAC covered at 100% of the PEHP allowed benefit. If the member does not meet MAC coverage criteria, the anesthesia will be completely denied. Medically indicated colon screening performed under the age of 45 is paid under regular benefits, not under ACA.
Labs and Imaging
General information
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
See complete list of exclusions.
08/31/16
September 2016
PROVIDER TIPS » Rheumatology
Preauthorization
- See this list of services that require preauthorization.
- To get preauthorization, get the appropriate form at PEHP for Providers and fax or mail it to us.
- These services generally require preauthorization:
- Inpatient hospital medical admissions at Primary Children’s Medical Center.
- These types of inpatient admissions: hospital rehabilitation, skilled nursing facilities, mental health, and substance abuse.
- All out-of-network inpatient admissions.
- For more information about preauthorization, contact your Provider Relations Representative.
Referrals/Networks
Networks
PEHP offers four different Networks. Please help us protect PEHP members from unnecessary large bills by referring them to providers in the PEHP network selected by the patient. This includes making sure that every person, lab, and facility involved in the patient’s care is not just contracted with PEHP but is specifically part of the member’s network. Otherwise, the patient can be balanced billed for out-of-network services. Find in-network providers at www.pehp.org/ProviderLookup.
PEHP Advantage » Primarily Intermountain Healthcare. Includes certain others based on geographic need.
PEHP Summit » Primarily University of Utah, IASIS, and MountainStar. Includes Primary Children’s Medical Center and all rural IHC facilities.
PEHP Preferred » Includes both Advantage and Summit providers.
PEHP Capital » Primarily IASIS and University of Utah Healthcare. Includes Primary Children’s Hospital and all rural facilities.
Affordable Care Act (ACA)
We cover preventive services at no cost to members. To help your office understand which CPT and diagnosis code combinations qualify for the ACA preventive visits, we have created this ACA Coding Table.
Prescription Drugs
General information
Get preauthorization by calling 801-366-7358. Forms are available at PEHP for Providers. Download the Covered Drug List.
Specialty information
Rheumatoid Arthritis
PEHP requires trial and failure of at least one DMARD. PEHP preferred agents (Enbrel, Cimzia, Remicade, Xeljanz, Actemra) at Tier A $150 max copayment.
Humira and Simponi are covered after failure of preferred agents at a tier C (20%) benefit.
Enbrel, Cimzia, Remicade, Actemra, and Xeljanz available through Accredo.
Juvenile Idiopathic Arthritis
PEHP requires 30-day trial and failure of at least one NSAID and eight-week trial and failure of at least one DMARD
PEHP preferred agents — Enbrel, Actemra, Orencia
Humira is covered following at least an 8 week trial and failure of Enbrel
Psoriatic Arthritis
PEHP requires 30-day trial and failure of at least one DMARD.
PEHP preferred agents – Enbrel, Cimzia, Remicade, Otezla, and Stelara (dose will not exceed 45mg)
Humira and Simponi are covered after failure of preferred agents
Labs and Imaging
Find in-network laboratories at www.pehp.org/ProviderLookup. In-network, free-standing labs, such as LabCorp and Quest Diagnostics, are less-expensive alternatives to sending the tests through a hospital. In general, the cost for labs are three to six times more expensive in a hospital outpatient setting. For example, in 2015, a comprehensive metabolic panel costs a patient around $13-14 when done in office or by an independent laboratory, compared to $86 at a hospital. Another example: Urinalysis done in office or by an independent laboratory costs a patient around $3-4, compared to $41 when done by a hospital. This same comparison is true for all labs. Free-standing imaging centers are also less expensive and are available in-network for patients on the PEHP Summit, Preferred, and Capital networks.
Exclusions
See complete list of exclusions.
08/31/16
Provider Basics is a reference guide to treating PEHP patients. Become familiar with this guide to reduce your payment denials and minimize uncovered and/or unnecessary healthcare costs for our members.
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.
Office Ally Electronic Claims
PEHP was first notified on Friday, February 26th, that beginning Monday, March 1st, Office Ally, will only submit paper claims. Please be advised that PEHP does not accept paper claims under the terms of our Provider Agreement. Accordingly, any claim submitted to PEHP by paper will be rejected. Fortunately, there are several options available through UHIN and PEHP for you to submit claims electronically to PEHP including:
- Your office can submit professional or facility claims by uploading files directly through the MYUHIN platform electronically at www.uhin.org/myuhin
- Your office may submit individual professional claims directly through the Provider Portal on the PEHP website.
- Your office may want to consider using a clearinghouse that does submit claims electronically through UHIN.
- Your office can advocate with Office Ally to submit claims and other transactions electronically through UHIN.
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:
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.
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.