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Provider Basics

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