Paper Claims Submission

Attention: Starting January 1, 2026 - We will only accept claims submitted electronically.

PEHP is currently processing electronically submitted dental claims in as little as 10 days. See how to submit claims electronically.

PEHP will accept paper claims only until December 31, 2025 if they are on the ADA J430D 2012 or newer claim form, are type written and include the following information:

BOX 48 - Billing Dentist name and address
BOX 49 - Billing entity NPI
BOX 51 - SSN or TIN
BOX 53 - Treating Dentist Name (PEHP will pay the treating Dentist)
BOX 54 - Treating Dentist NPI
BOX 56 - Address where services were performed.

If this information is not completed on your ADA J430D 2012 or newer claim form, your submission may be rejected.

Paper claim submissions should be mailed to:

PEHP
Attn: Claims
560 East 200 South
Salt Lake City, UT 84102-2004