org Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Electronic Trading Partner Agreement (ETPA) form must be executed by the provider before they are allowed access to the PEHP Provider secure website which provides member eligibility, claims status, Clear Claim Connection (PEHP claim edit tool), Pharmacy Prior-Authorization forms, and other proprietary information. Access your PEHP benefit account, view your balance, submit claims, and more. Forms are available at myPEHP for Providers . This parenting program offers valuable insights and practical tips that can help you create a positive and nurturing environment for your child. Contact PEHP Customer Service at 801-366-7555 to determine eligibility for benefits. Discover your path to wellness with PEHP and win exciting prizes along the way! Whether you’re trying to be more active, improve your eating habits, boost your mental well-being, or get parenting support - you’ll find something to help you achieve your health and wellness goals. If you use your old PEHP ID number beginning in "174100" after your new plan year begins, your claims will be denied. Please contact PEHP at 801-366-7555 or 1-800-765-7347 (TTY:711) for preauthorization. Hearing Officer Appeal – A Provider may appeal the results of a First-Level Appeal within 30 days by submitting a written petition to the Hearing Officer in accordance with the procedure set forth in Utah Code Ann PEHP is replacing its claims payment and administration system to better serve you and our members. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim As of January 1, 2015, PEHP requires all contracted medical and facility providers to submit claims electronically. Obtain contracted fees via Fee Schedule Lookup. Non-Contracted Provider? Request Preauthorization Learn how to create a new provider account on pehpproviders. Preferred Network. Here are some of the concepts the program explores: Meeting basic needs. Your prescription drug benefit Download the Covered Drug List to see the following:. You can access your Express Scripts Account via your PEHP account. Contracted Providers. healthtrioconnect. PEHP contracts directly with all providers in this network. Electronic Trading Partner Agreement (ETPA) form must be executed by the provider before they are allowed access to the PEHP Provider secure website which provides member eligibility, claims status, Clear Claim Connection (PEHP claim edit tool), Pharmacy Prior-Authorization forms, and other proprietary information. PEHP now offers an online tool which allows providers to create a primary or COB claim directly from pehp. Providers who contract with PEHP must meet PEHP credentialing requirements. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim PEHP Customer Service Line: 801-366-7555 or 800-765-7347 (TTY:711) . The Covered Drug List is a listing of prescription medications that provide the best overall value based on quality, safety, effectiveness, and cost. For rural areas outside the Wasatch front, other specialties may be needed. See the types of claims PEHP will accept by paper. Providers must obtain a preauthorization by calling 801-366-7358. The “Submit Medical Claims” link is located on the left hand side of the home screen in the provider portal. Start Your Wellness Journey We will locate your record and send you an email with password reset instructions. Download medical preauthorization forms. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim Access your PEHP benefit account, view your balance, submit claims, and more. com, a portal for accessing and managing your health plan information and benefits. , call 801-366-7775. Sign in with your username and password. By 2010, PEHP was collecting over a half billion dollars annually to cover the cost of health care. » PEHP Online Account: If you haven’t already, create a PEHP online account to access your claims, find providers, view copays, deductibles, out-of-pocket max, benefits Check Eligibility Claim Status/RemIttanc PEI-IP PROVIDERS Main Menu profile Member I Check Eligibility Claim Status/RemIttance EDI Claim Acknowledgement New! Clinical Policies Billing Physical Address Forms Medical Preauth Forms e salt Lake clinic Last Login 09/13/2022 at 03:4Spm Kim Abbott Lest Log in: 09/13/2022 at fl:S9em Abbott, Kim PEHP is replacing its claims payment and administration system to better serve you and our members. ) All out-of-state surgeries require preauthorization from PEHP. Some PEHP dental plans require a six-month waiting period before orthodontic benefits are allowed. This is true for any individual provider or for group providers who submit a new application and for any provider that is added to an existing group contract. Provider Basics is a reference guide to treating PEHP patients. George, UT 84770 By appointment only: Weekdays from 8 a. Loading. As a partner in the delivery of optimal healthcare services to our members and your patients, we are continually striving to assist you in the Dental Benefit Breakdown. PEHP FLEX$ is a flexible spending account that saves you money by setting aside a portion of your pre-tax salary to pay eligible expenses. Otherwise, your benefits could be reduced or denied, potentially costing you thousands of dollars. Check status of submitted claims and payment information. Genetic testing is commonly overlooked. PEHP does not endorse these products or services provided by third party vendors. org via the secure provider portal. - 5:00 p. You can also get your biometrics from your health care provider at your annual preventive visit. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Access your PEHP benefit account, view your balance, submit claims, and more. Since PEHP will be paying claims from two systems during this transition, you will need to submit claims with the correct ID number (as shown on the PEHP ID card). PEHP requires the primary carrier’s Explanation of Benefits (EOB) information to be included on the claim. Download pharmacy preauthorization forms. PEHP is replacing its claims payment and administration system to better serve you and our members. helpdesk@pehp. Find complete details about your PEHP benefits in your Benefits Guide/Summary and Master Policy. PEHP Credentialing Policies . Non-Contracted Providers UHIN is a nonprofit, broad-based coalition of Utah healthcare insurers, providers, and others, including local government entities. Find these documents when you log in to your PEHP account. See on Google Maps. Effective immediately: PEHP no longer accepts paper EFT PEHP is replacing its claims payment and administration system to better serve you and our members. Your prescription drug benefit To get it, you or your doctor must call PEHP. to 5 p. Once you receive this email, you can create your online personal account at PEHP for Members, where you can enroll in a medical and dental plan. If you're a new provider serving PEHP members and need to be added to our system to submit claims via our portal, UHIN, or your preferred clearinghouse, please fill out the Provider Account Information Form . If you have preauthorization questions, call PEHP at 801-366-7555. quested by PEHP to prove benefit eligibility, and that if I am unable or unwilling to produce such documents, my appeal may be dismissed. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; PEHP offers several network options that cover every major hospital in Utah and thousands of providers. org to provide free parenting resources to our members. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim 801-366-7555 or 800-765-7347. (except Holidays) 801-366-7544 800-753-7818 edi. PEHP makes no guarantee or warranty regarding the products offered through PEHPplus. Obtain benefit limits information. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; » PEHP Member ID Number: Be sure to provide your PEHP member ID number, which starts with “M000,” when visiting providers to ensure accurate claims processing. See your plan details to confirm if this applies to your plan. peHp’s online enrollment application offers a simple, convenient way to enroll for benefits electronically. Providers are contracted at listed addresses only. 270/271: Health Care Eligibility and Benefit Inquiry – Real time or batch eligibility and benefit PEHP Online Enrollment » A step-by-step guide for employees say goodbye to paperwork. To get it, you or your doctor must call PEHP. Your new ID number begins with "M000. Send all forms and applicaple patient notes to document clinical information. See on Google Maps Loading. Claims are paid by PEHP directly to Contracted Providers . Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Access your PEHP benefit account, view your balance, submit claims, and more. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim Access member eligibility and effective dates. From your PEHP account homepage: Go to the "My Benefits" menu ; Find "Benefit Summaries" Choose the "Benefits Summary" or "Master Policy" folder to find documents specific to your benefits. Local Governments Risk Pool Preferred Choice Option I Here's what providers need to know: Currently, only 30% of our total membership has been migrated during phases 1 and 2. Please note, the turnaround time for paper claims is longer than electronically submitted claims due to the extra handling required. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim Learn how to create a new provider account on pehpproviders. Become familiar with this guide to reduce your payment denials and minimize uncovered and/or unnecessary healthcare costs for our members. These services and products are offered at discounts only because they are not covered benefits under a PEHP medical plan. Learn how to create a new provider account on pehpproviders. it’s quick and easy to use this helpful peHp feature. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim Welcome to PEHP! You'll get an email from the State with your PEHP Member ID number after you begin your job. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; PEHP partnered with ParentGuidance. Use the Message Center to contact PEHP (801) 366-7555 or (800) 765-7347 (Statewide Customer Service) Visit us weekdays from 8 a. Our Customer Service Representatives and Provider Specialists answer questions relating to claims, member eligibility, and benefits. PEHP currently supports the following transactions: 837: Health Care Claim – PEHP accepts dental, professional and institutional claims. MultiPlan reserves the right to change or update provider lists at any time. Fax the form back to the PEHP Case Management Department at 801-328-7449 or mail to: PEHP Case Management, 560 East 200 South Salt Lake City, UT 84102. There are two different FLEX$ accounts – one for medical expenses and another to help with dependent childcare costs – and each has important rules to keep in mind when using the benefit. I also understand that I will be fully responsible Primary Children’s Medical Center and all Intermountain Health rural facilities are also included. As of January 1, 2015, PEHP requires all contracted medical and facility providers to submit claims electronically. . Claims must be submitted to PEHP within 15 months from the date of service to be eligible. Monday-Friday, 8 a. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Loading. When PEHP becomes the secondary payer, the member is responsible to ensure timely filing from all providers. Southern Utah Branch Office 20 North Main Street #206 St. Most doctors know how and when to do this, but be sure to verify with your doctor or us. m. " Please discard your old PEHP card and begin using the new card when you visit providers. 801-366-7555 or 800-765-7347. Some of the many benefits of submitting claims electronically include: Improved cash flow Access member eligibility and effective dates. Your new card will have a new member ID number and your plan benefits. PEHP Member Guide - This guide will help you understand basic health insurance terms, how to maximize your PEHP benefits, and give you the tools you need to make the best healthcare decisions for you and your family. Customer Services and Provider Specialists. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim Choose Your Path to Wellness . Under the My Benefits menu, choose “Access Express Scripts Account. Access member eligibility and effective dates. The ETPA agreement governs the rules by which providers agree to access Individually Identifiable Health Information that PEHP provides ONLY through the Classic Provider Portal. ” PEHP Covered Drug List. Give your employees ultimate provider access by offering up to three networks or just one network for more savings. Preferred Medications; Non-Preferred Medications; Specialty Medications; Non-Covered Medications PEHP Customer Service Line: 801-366-7555 or 800-765-7347 (TTY:711) PEHP is replacing its claims payment and administration system to better serve you and our members. This network consists of all providers and facilities in both the Summit and Advantage networks. New tools and payment models were introduced, including new provider payment models, value providers and telemedicine. PEHP generally processes claims within 45 days. An overview of PEHP dental benefits when using an in-network provider. Some of the many benefits of submitting claims electronically include: Improved cash flow To register for your annual screening, login to your PEHP account and select “Register for Testing Session” under the Wellness menu or call us at 801-366-7300. If you have a patient with complex medical needs, please call the PEHP prenotification line at 801-366-7755 or 800-753-7490 and the case will be forwarded to our case management nursing staff for review. UHIN provides a private and secure gateway for electronic data exchanges. If you have not previously signed an ETPA and need access to the Classic Provider Portal , follow these steps: PEHP pays the provider over time once you start treatment, typically over the course of 12-24 months. We'll let your office know if the preauthorization request has been approved or denied. PEHP will return a Functional Acknowledgment (999) report and a Front End Acknowledgment (277CA) report. Please note: once enrollment in EFT is complete, paper remittance and checks will no longer be sent. The transition to the new system will be done in phases by employer renewal dates. PEHP assumes no responsibility or liability for any material that may be accessed on other Web sites reached through myPEHP Providers , nor does PEHP make any representation regarding the quality of any product or service contained at any such site. Enter your User Name Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; PEHP is currently accepting applications from medical providers in the following specialties in the Wasatch front: psychiatry, endocrinology and rheumatology. (You're unable to enroll until you have a Member ID number. Vendors may alter their relationship with PEHPplus at For clarification about how a claim was processed, Providers may contact PEHP online or by calling 801-366-7555 or 800-765-7347. The PEHP for PROVIDERS is a secured online provider site allowing you to easily and cost-effectively access resources and information that can simplify and expedite your organization’s daily tasks. EDI Helpdesk Contact Information. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim PEHP requires all providers to submit their claims electronically. Here’s how URS/PEHP Online Enrollment You can access your Express Scripts Account via your PEHP account. If an individual provider or group fails to keep PEHP informed of any provider Access member eligibility and effective dates. Obtain deductibles. Providers must be able to receive an electronic remittance (835) and/or be able to download and view remittances through the PEHP website. By 2013, PEHP became the first Utah company to offer complete health care rate transparency through their Cost & Quality tools. Who is eligible for a PEHP? Maricopa County Retirees who meet all of the following criteria are eligible for a PEHP: • Retiree must officially retire on or after January 1,2007 from Maricopa County as verified by the appropriate state retirement system; Choose Your Path to Wellness . Payments. Please note that some benefits mentioned in the guide may not apply to you. Until the transition is complete, you may need to login to your existing and new provider account to verify member benefits eligibility, submit claims, see claim To get it, you or your doctor must call PEHP. If an individual provider or group fails to keep PEHP informed of any provider PEHP requires all providers to submit their claims electronically. gb gt xy kw aw ut wr qn bk bt