Orchard - Unchanged

Paper Claims Submission

PEHP only accepts paper claims for the following:

  • Dental
  • Tertiary (2 separate EOBs attached)
  • Include Medical Records attached
  • Air ambulance claims with records
  • Invoices for vaccine clinics (CNS, Costco, etc. for employers)

Please submit all claims to:

PEHP Claims Department
560 E 200 S
Salt Lake City, Utah 84102-2004

Claims must be sent on appropriate claim forms: UB-04 or CMS-1500.  Handwritten claims will not be accepted.


Required Information for Claims Submission

Codes (include all applicable):

  • CPT (Current Procedural Terminology)
  • HCPCS (Health Care Financing Administration’s Common Procedural Coding System)
  • ICD-10 (International Classification of Diseases)
  • NDC # (National Drug Code)
  • Revenue
  • CDT



  • Rendering provider name
  • Rendering provider NPI #
  • Billing provider tax ID #



  • Provider’s charge(s) for the service(s) rendered


Processing / Turn Around Time

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



Contracted Providers

  • Claims are paid by PEHP directly to Contracted Providers


Non-Contracted Providers

  • Claims are paid by PEHP directly to the member in the name of the provider unless otherwise required by the No Surprises Act.