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Provider News & Info


August 2023

Important: Claim submission tips to avoid payment delays

When submitting claims to PEHP via our new system or your clearinghouse (such as UHIN), please follow these guidelines to avoid payment delays:


  1. Box 24 (Rendering Provider/Practitioner ID #): Ensure the name spelling and NPI match accurately. Any discrepancy will result in automatic claim rejection by our new system.
  2. Box 32 (Service Facility Location/Supplier Location): Input the official name of your practice/facility precisely. Failure to do so may lead to unrecognized location in our new system.
  3. Box 33 (Billing Provider Info/Supplier Information): Verify that your company's IRS EIN/147c matches the details PEHP has on record for your correspondence and pay-to address.


If your claim is rejected, please contact us to identify the specific areas that didn't align correctly with our new system.


We appreciate your attention to these details as they contribute to a seamless claims process.

PEHP Medicare Supplement claims processing


Some of our members are enrolled in both Medicare and a PEHP Medicare supplement plan to help cover services Medicare doesn't cover. The biggest challenge with our new system is the integration with Medicare for accurate claims processing and payment, mostly centered around data synchronization between PEHP, the Federal Medicare Program, and providers.


While we've made significant progress in correcting and processing Medicare supplement claims, glitches remain. To facilitate a streamlined claims process, kindly consider the following:

  1. Member ID and Location Match: When submitting a claim form to Medicare for a patient with a PEHP Medicare Supplement plan, please ensure that the member ID number and your facility/practitioner location correspond accurately with our records at PEHP.
  2. Update Information with Medicare: If updates are needed for your location information with Medicare, we recommend contacting them directly to ensure alignment.
  3. Update Information with PEHP: For any updates to your location information within PEHP's system, please complete and submit this form electronically to providersubmissions@pehp.org


Making sure your provider information and patient information match with Medicare and PEHP is critical for a seamless claim process.


Thank you for your attention in this important matter.

Can a contracted provider request a member to pay PEHP's portion of a submitted claim?


No, this is not allowed under our contract terms. Accepting payment from a member for a claim submitted to PEHP creates complications for the member, the provider, and PEHP in terms of payment and accounting. It is essential to adhere to the contractual terms to ensure a smooth claims process.

 

How do I view remittance advice/EOP in the New Provider Portal?


The best way to view a remittance advice/EOP for a claim submitted in the new system is to log in to the New Portal and choose Office Management----> Communications Archive from menu on top. Make sure to select the provider entry with the Supplier number “S000xxx” (not the Supplier Location or Practitioner number). If you don’t see a remittance advice/EOP for a past claim, please send us a message via the Message Center in the New Portal.

 

How do I get 835 files for a past payment?


If you’re missing 835 files for a past payment, please call our EDI department at 801-366-7544 or email edi.helpdesk@pehp.org. Or reach out to your clearinghouse.

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How to contact us

If you need to report a new issue or have any concerns, the best way to reach us is by calling our Member and Provider Service Center at 801-366-7555 or sending us a message via the Message Center in the New Portal.

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