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Paper Claims Submission

Accepted Forms Claims need to be sent on appropriate claim forms: UB-04 or HCFA-1500
Required Information for Claims Submission Codes:
  • The CPT (Current Procedural Terminology)
  • HCPCS (Health Care Financing Administration’s Common Procedural Coding System)
  • ICD-9 (International Classification of Diseases)
  • NDC # (National Drug Code) – if applicable

Charges:

Provider’s charge must be provided
Coordination of Benefits PEHP currently does not accept COB claims electronically. Please submit these types of claims paper, with the appropriate Explanation of Benefits attached. Please note, COB claims will take longer for processing, due to mailing, scanning, review, processing etc.
Processing / Turn Around Time PEHP contracts with many different Employer Groups; therefore, there is no specific time frame.  The claims turnaround time is based on the Employer Group that your member is with.  Please note, paper claims turnaround time is longer than if the claim was submitted electronically, as electronic claims have first priority.
Payments Contracted Providers
-Claims are always paid directly to Contracted Providers

Non-Contracted Providers
-PEHP shall pay claims directly to the member, unless provider accepts assignment
Claims Address

Please submit all claims to:
PEHP
Claims Division
560 E 200 S

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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