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Paper Claims Submission

Attention: Submit Claims Electronically for Faster Payment

PEHP is currently processing electronically submitted dental claims in as little as 10 days. To encourage all dentists to transition to electronic submissions and receive faster payments, we've removed the need for imaging and other paper documentation with your claims. See how to submit claims electronically.

PEHP does accept paper claims 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:

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