Provider News & Info

November 2023

Great news! Starting January 1, 2024, PEHP is proud to offer our members generic Humalog Lispro insulin at No Cost. You read that right – we're eliminating the copay for insulin, making it $0 for all PEHP members.

If you have patients with diabetes who need insulin, please submit prescriptions for generic Humalog Lispro insulin beginning January 1.

If you have any questions or concerns about this change, don't hesitate to reach out to our pharmacy department at 801-366-7551.

New PEHP preauthorization requirements

We want to keep you informed of new preauthorization (PA) requirements* on important medical procedures. Please familiarize yourself with these new PA requirements to provide the best care for your patients without unnecessary delays.

Effective October 1, 2023

Transplant surgeries related to the kidney, liver, pancreas, and heart. The affected CPT codes include: 50323, 50325, 50327, 50328, 50329, 50340, 50360, 50365, 50370, 50380, 47135, 47143, 47144, 47145, 47146, 47147, 33927, 33928, 33929, 33944, 33945, 81595, L8698, 33979, 33980, 33982, 33983, 48160, 48551, 48552, 48554, 48556, 50323, 50325, 50327, 50328, 50329, 50360, 50365, 50370, and S2065.

Effective January 1, 2024

Cardiac Ablation for the following CPT codes: 33250, 33251, 33254, 33256, 33257, 33259, 33261, 93613, 93650, 93653, 93654, 93655, 93656, 93657.

Cell Free Fetal DNA Testing for CPT code 81420.

You can view all PEHP clinical policies, authorization forms, and master policies via the New Portal. Here’s how:

• 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.

*Please note that not all affected codes may be listed, and codes are subject to change at PEHP's discretion.

Guaranteed lowest drug price with PEHP

We're happy to report that when PEHP members fill a prescription, they’re automatically guaranteed the lowest price possible - all thanks to a new partnership through our pharmacy benefit manager (Express Scripts) and GoodRx.



If GoodRx has a better price than Express Scripts, PEHP members automatically get the better price through GoodRx and don't need to show a GoodRx coupon. Please share this important update with your patients.

How do providers update demographic information?

To update your name, address, phone number, or other demographic information please complete the Provider Account Information Form. Note: Do not fill out this form if you work under a new TIN.

How can providers access PEHP fee schedules?

In-network providers can conveniently access and review current/upcoming fee schedules online. Simply log in to your Classic Account, select "Fee Schedule Lookup" from the left menu, and specify the date of service, provider panel, and code criteria.

Be in the Know:

Tips to avoid delays in claims payment

PEHP is replacing its claims payment system in phases. To avoid delays in payment, here’s what you need to know:



• Make sure to verify your patient’s PEHP ID number at every visit using the Member ID Lookup Tool available in the Classic Account --> Choose Provider --> Member ID Lookup Tool. Note: You must input the subscriber ID number with no extensions/hyphens to verify eligibility.
• If the member ID number begins with 174100, you need to submit claims using the Classic Account.
• If the member ID number begins with M0000, you need to submit claims using the New Account.
• If possible, please avoid submitting paper claims as they require manual processing and will substantially delay payment.

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 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.

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