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Paper Claims Submission  

PEHP does accept paper claims if they are on the J400 claim form, are type written and include the following information:

Box 48

 Billing Dentists name and address

Box 49

 Billing entity NPI

Box 51

 SSN or TIN

Box 53

 Treating Dentist’s Name (PEHP will pay the treating Dentist)

Box 54

 Treating dentist’s NPI

Box 56

 Address where services were preformed

If this information is not completed on your J400 claim form your submission maybe rejected.
Paper claim submissions should be mailed to:

Public Employees Health Program
Attn: Claims
560 East 200 South
Salt Lake City, Utah 84102-2004

Beginning July 1, 2010

PEHP will no longer be administering any CHIP medical or dental plans.

PEHP will continue to pay CHIP claims with dates of service prior to July 1, 2010.

Start preparing now....

Start preparing now for the electronic healthcare transactions change to Version 5010 and the ICD-10 conversion. Speak with your practice management vendor or clearinghouse about these coming changes.

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