Stay Informed: PEHP policy changes
We want to keep you updated on important changes to preauthorization (PA) requirements and policies regarding medical procedures. Please familiarize yourself with these changes to provide the best care for your patients without unnecessary delays.
Effective November 1, 2024
In-Network Inpatient Hospital Medical admissions, including Mental Health and Substance abuse admissions, will receive coverage for the first four (4) days without preauthorization (PA) under our new policy, “Inpatient Admission – Four Day Approval Process.”
Other Key Changes
PA Required After 4 Days (except for the following):
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Out-of-state facility requests for members with an out-of-state address.
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Emergency department admissions for members with a Utah address, PEHP will approve 4 days and request clinicals.
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Neonatal Intensive Care Unit (NICU): Up to 32 weeks gestation can be approved; infants over 32 weeks can receive up to 7 days approval upfront.
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Out-of-state inpatient maternity for members with an out-of-state address, 4 days approved upfront.
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Cystic Fibrosis clean-out: 7 days approved upfront.
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Bone Marrow Transplant or Solid Organ Transplant: 7 days approved upfront.
You can view all PEHP clinical policies, authorization forms, and master policies via the New Portal:
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Log in to the New Portal and choose Office Management --> Communications Archive from menu on top.
- Next, choose a provider from your office.
- Then, choose the policy or authorization document from the Document Type drop-down menu.
To obtain PA, please call PEHP at 801-366-7755.
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