Provider News & Info
Summer 2024
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Understanding user roles in the New Provider Portal |
The first person to create an account in the New Provider Portal is automatically designated as the Local Administrator for your office. You should only create an account if you’re the main office contact for your practice. The Local Administrator has full access to all portal functions, including adding additional users with specific roles:
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Access Management: Can access Benefits & Eligibility, Reports, and the Message Center.
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Eligibility, Claims, & Billing: Can access patient eligibility, claims, billing, and the Message Center.
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Referrals & Authorizations: Can submit authorizations, referrals, and access the Message Center.
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Local Administrator: If you want someone else from your office to have full access to the portal, including the ability to add other users and update EFT information, you can assign them as Local Administrators too.
Reminder! Only create an account if you’re the main office contact for your practice. Additional users must be added by the Local Administrator using the instructions on page 3 of the Provider User Guide.
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Important Notice!
The Claim Submission-Medical option is currently unavailable. We're actively working to resolve the issue and apologize for any inconvenience. We appreciate your patience. If you encounter other issues with the New Provider Portal, please let us know by sending a message via the Message Center. Include your browser, username, TIN, patient information (if applicable), and any screenshots.
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New fee schedules effective July 1, 2024 |
We updated our fee schedules based on the CMS 2024 Relative Value Units (RVUs). The resulting fee per code might result in an increase, decrease, or no change.
To assess the potential impact on your reimbursement, use our online Fee Schedule Lookup tool in the Classic Portal. You can compare previous and current fees and download them to an Excel spreadsheet.
The 2024 fee schedule will be effective July 1 and available for review online no later than July 15.
If you have questions, please send us a message via the Message Center in the New Provider Portal.
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New PEHP preauthorization requirements and policy changes
We want to keep you informed of new preauthorization (PA) requirements* and new policy changes on important medical procedures. Please familiarize yourself with these new PA requirements to provide the best care for your patients without unnecessary delays.
Effective July 1, 2024
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Preauthorization required for radiation associated with the following CPT Codes: 77261-77299, 77295-77370, 77399-77417, 77427-77499.
- Policy updates related to wound care. New policy defines benefit information, eligibility, and qualifying procedures.
You can view all PEHP clinical policies, authorization forms, and master policies via the New Provider Portal. Here’s how:
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Log in to the New Provider 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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*Please note that not all affected codes may be listed, and codes are subject to change at PEHP's discretion. | |
Impacted by the Change Healthcare cyberattack?
If your office has been affected by the cyberattack on Change Healthcare, we understand the challenges you may be facing in submitting claims.
If you've switched to a new clearinghouse or billing service, please send us your new Trading Partner Number via the Provider Account Information Form. This will ensure a smooth transition and uninterrupted claims processing and payment.
Important! PEHP requires all providers to submit claims electronically. Paper claims are only accepted for certain services. Learn More.
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How to check benefits and eligibility in the New Provider Portal
The process to check patient benefit eligibility with PEHP is simple. Here’s how.
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Login to the New Provider Portal.
- From the Office Management menu, go to Eligibility.
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On the Eligibility Search page, enter the Patient’s Name, Subscriber ID, or Social Security Number, along with the patient’s Date of Birth. Both fields are required.
- Once the Eligibility Search Results are displayed, click on the Patient’s name.
- Next, search for a provider if you have more than 50 providers in your office. If you have less than 50 providers in your office, select a provider from the drop-down. Then choose "Health Benefit Plan Coverage" or "Dental Coverage" under Service Type. Note: Other service types are currently unavailable.
- The system will return Benefits and Eligibility based on the Service Type selected.
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We offer wellness programs to help members improve their health. We also reward them!
Did you know? PEHP offers a variety of wellness programs to its members designed to help improve their overall health and well-being. Plus, they can earn cash rebates and prizes for actively working towards achieving their wellness goals.
Here are some examples of programs offered at no cost:
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Physical Well-Being: A variety of physical activities that encourage members to engage in healthy behaviors.
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Mental & Emotional Well-Being: Mindfulness and meditation activities that help individuals reduce stress.
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Healthy Eating: Yummy and healthy recipes to add variety to diet and be creative in the kitchen.
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Family & Social Well-Being: Weekly activities to build and maintain strong relationships with loved ones.
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Weight Management: Personalized coaching and support to help individuals achieve a healthy weight.
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Diabetes Help: Classes, programs, and resources to help manage diabetes.
Please encourage your patients to take advantage of their PEHP wellness benefits.
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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 contact us is via the secure Message Center in the New Provider Portal. When calling us (801-366-7555), please select the correct queue within the provider phone tree to avoid longer wait times. Choosing the right option ensures faster assistance.
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
801-419-3699
cammie.keim@pehp.org
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