Claims & payment changes effective January 1, 2026
Starting January 1, 2026, PEHP is implementing changes to its claims and payment processes. Please review the key changes below and plan accordingly to avoid delays:
What’s changing?
- Electronic claims required (see how). Paper claims will no longer be accepted.
- Dental preauthorization (PA) required for certain procedures. See list.
- Electronic payments only (see how to sign up for EFT). Otherwise, a $20 check fee will apply.
Why the changes?
- Faster claims processing: Our upgraded auto-adjudicating system processes clean claims in less than 10 days.
- Ensure medical necessity and prevent service duplication: Our new system is programmed to automatically detect and verify PA requirements during claim processing.
- Streamline payments: Paper checks create unnecessary administrative burdens for everyone – switching to EFT ensures you get paid faster.
If you have any questions or need support with these changes, please contact us via the Message Center in the New Portal or call 801-366-7555.