Temporary slower claims processing and payments due to latest software upgrade

On July 1, 2026, PEHP implemented the final software upgrade for our new claims payment system, and we are currently working through the stabilization period.

This upgrade was needed to enhance our claims editing software, which incorporates Medicare NCCI edits and allows customization to align with PEHP’s clinical policies.

While we are currently experiencing slower processing times, this delay is only temporary.

Please avoid submitting duplicate claims to help us prevent additional delays. Resubmitted claims will be denied as duplicates unless the claim is identified as a corrected claim and includes the original claim number.

We appreciate your patience as we complete this transition and finalize improvements to our claims payment system.

If you have any questions or concerns, please contact us through the Message Center in your PEHP account.

Helpful Tips to Avoid Delays

Billing Address Consistency

Formatting

(Mixed Case Errors)

CAQH Review

The billing address on submitted claims must match what is in our system. Local administrators can run Provider Report to review exact formatting of names, specialties and addresses in system.

Claims will not match if member names, provider names, or addresses are submitted in all capital letters.

Verify the following in your CAQH profile:

Practice locations
Tax ID and NPI
Contact details

Providers must update their clearinghouse whenever they update their address with us.

Confirm your clearinghouse is not converting names or addresses to all caps.

Providers with multiple locations under one supplier must bill using the supplier’s billing address on file for each location.

Submitting Claim Corrections
For adding/removing/editing codes, dollar amounts, units, etc.:
Include the original claim number for corrections on Denied or Final claims.
Mark corrections using frequency code 7.
Note: Rejected claims must be resubmitted as new claims.

How to access the Medical & Dental Fee Schedule Lookup

Log in to the New Portal
Under the Quick Access menu, click Fee Schedule Lookup.
On the next screen, select only the Supplier ID (e.g. S0000xxx or S1111xxx) from the dropdown menu. Selecting a Location or Provider record will not display the fee schedule. Note: For offices with multiple NPIs and locations, click Search Provider, type in the name associated with the TIN and then More Info to find the Supplier ID (e.g. S0000xxxx or S1111xxx).
Complete all fields and click the Lookup Fees button. Note: CDT dental codes must have the D###.

Review Fee Schedule

How to contact us

Claims, provider portal, and other customer service items

If you need to report a new issue or have any concerns, the best way to reach us is via the secure Message Center in your PEHP account. When calling us (801-366-7555), please select the correct queue within the provider phone tree to avoid longer wait times.

Important! If you need to send us documents, please use the Message Center.

PEHP Provider Contracts

If you have questions about your contract with PEHP, please contact the following:

Todd Sprouse, Director of Provider Contracting

801-803-0143

todd.sprouse@pehp.org

Mike Corrigan, Senior Provider Contracting Manager

801-597-5682

mike.corrigan@pehp.org

Cammie Keim, Provider Contracting Manager

801-366-7339

cammie.keim@pehp.org