We're replacing our claims payment system in phases. Here's what you need to know.

We would like to remind you that we're in the process of replacing our claims payment system in phases based on when a member's plan year begins (January, May, July, or September). Some PEHP members were migrated to the new system on September 1, 2022, and January 1, 2023. The next big migration will occur on July 1, 2023, which will include more than 100,000 members.

To avoid delays in payment, make sure to do the following:

Ask to see your patient's ID card at every visit. They will have a new card for the new plan year.
Bill services before the end of a patient's current year to the 174100 number using the Classic Portal.
Bill services after the start of a patient's new plan year to the M000 number using the New Portal.

If you need help finding something, check out these handy how-to guides and videos.

Got questions about the new claims payment system and the new Provider Portal?

Find answers to frequently asked questions:

We recently made changes to the provider appeal process. Effective January 2023, all providers must submit a First Level Appeal Form.

As part of the appeal process, the provider must:

Identify with specificity PEHP’s error in processing a claim or making a decision.
Include relevant documentation and identify the page number and sections that support your position.
Detail how the claim or decision should be corrected.
Each appeal must cover a single claim unless the same error, same documentation, and same correction apply for bundled claims.

Thank you for creating a new PEHP online account. Here are some things you can do when you log in to your PEHP account:

If you encounter issues with your new PEHP account, please notify us via the Message Center within your account and we’ll investigate it.