EDI Services

PEHP currently supports the following transactions:

• 270: Health Care Eligibility and Benefit Inquiry – Real time or batch eligibility and benefit requests. Currently available through the UHINT tool, may also be available through your practice management system
• 271: Health Care Eligibility and Benefit Response – PEHP will return a response to your eligibility and benefit inquiry. It will be sent in the same manner received
• 276: Health Care Claim Status Inquiry – Real time or batch status reports on claims that were previously submitted. Currently available through the UHINT tool, may also be available through your practice management system
• 277: Health Care Claim Status Response – PEHP will return a response to your claim status inquiry. It will be sent in the same manner received
• 277FE: Unsolicited Claim Status – PEHP will send a front end claim status response for all claim files you send to us. This response will tell you which of your claims were accepted into our adjudication system. If the claim is rejected, the response will give you the appropriate code for why we rejected it
• 835: Health Care Claim Payment and Remittance Advice – Providers have the option of receiving an electronic remittance, either directly through UHIN or by printing a paper remittance from our website. Any of these options allow providers to sign up for Electronic Funds Transfer (EFT)
• 837: Health Care Claim – PEHP accepts Dental, Professional and Institutional claims. PEHP will return a Functional Acknowledgment (997) report and a Front End Acknowledgment (277FE) report
• Electronic Funds Transfer (EFT) – PEHP will send an electronic remittance (835) to the provider and transfer funds to the provider’s bank. Providers that receive electronic remittance are eligible for Electronic Funds Transfer