Orchard - Unchanged

Provider Basics

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

Provider Basics PDF file 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.

Access Provider Directory

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.