Orchard - Unchanged

Paper Claims Submission

PEHP only accepts paper claims for the following:

  • Providers not contracted with any PEHP networks
  • Claims that require medical records - This does not include COB claims
  • PEHP is the tertiary payer

Accepted Forms

Claims need to be sent on appropriate claim forms: UB-04 or HCFA-1500

Required Information for Claims Submission


  • CPT (Current Procedural Terminology)
  • HCPCS (Health Care Financing Administration’s Common Procedural Coding System)
  • ICD-9 (International Classification of Diseases) - DOS prior to 10/1/15
  • ICD-10 (International Classification of Diseases) - DOS 10/1/15 and after
  • NDC # (National Drug Code) – if applicable


  • Rendering provider
  • Rendering provider NPI #


Provider’s charge must be provided

Processing / Turn Around Time

PEHP processes claims within 45 days or less. Please note, paper claims turnaround time is longer than if the claim was submitted electronically due to extra handling required for paper claims.


Contracted Providers
- Claims are always paid directly to Contracted Providers

Non-Contracted Providers
- PEHP shall pay claims directly to the member in the name of the provider

Claims Address:

Please submit all claims to:

Please submit all claims to: PEHP
Claims Division
560 E 200 S
Salt Lake City, Utah 84102-2004

Hand written claims will not be accepted.