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Provider News & Info


Fall 2024

PEHP offers free insulin and diabetes management resources

To help your patients effectively manage their diabetes, PEHP provides several key benefits and programs:


Insulin & Test Strips

  • Fast-Acting Insulin: Insulin Lispro (generic Humalog) is available at No Cost.
  • Blood Glucose Test Strips: FreeStyle blood glucose test strips are available at a Tier 1* copay before deductible.
  • Long-Acting Insulin: Lantus is available at a Tier 1 copay before deductible.


Education & Support

  • Diabetes & You Class: This four-week online class, led by a registered dietitian, offers tips for making healthy choices and managing diabetes. Eligible participants can earn a $100 rebate.
  • Health Coaching: Personalized health coaching is available for members with an A1c level greater than 8.


Please share this valuable information with your patients to support their diabetes management.


*To view drug tier pricing, please refer to the PEHP Covered Drug List.

Learn More

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 August 12, 2024

  • PEHP will no longer cover cell-free fetal DNA testing for all pregnant women or genetic carrier screening for all adults. 


Effective October 1, 2024

  • Preauthorization is not required for Beyfortus unless:
  • It is administered to an infant whose mother received Abrysvo. In some cases, administration of Abrysvo to the expectant mother and Beyfortus to the infant is covered (e.g. high risk cases, infants delivered less than four weeks following Abrysvo administration.)
  • The child is entering their second RSV season.


Effective October 15, 2024

  • Acute care hospitals can discharge PEHP members to in-network skilled nursing facilities (SNF) and residential treatment centers (RTC) in Utah without preauthorization. Additionally, these facilities can accept PEHP members without PA for up to four days, in accordance with the new policy, “Skilled Nursing Facility Care” and “Residential Treatment Center.” Note that if hospitals and SNFs/RTCs prefer to obtain PA, they must opt-out of this new policy.


You can view all PEHP clinical policies, authorization forms, and master policies via the New Portal:


  • 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.

See Medical PA Requirements

Help your patients save on drug costs with PEHP's cost comparison tool


You can help your patients save on medications with the Compare Prescription Costs tool in the PEHP Provider Directory. This handy resource allows you to see medication options for common conditions, compare costs, and find nearby pharmacies, including home delivery services that are often more economical.


To access the tool, log in to your PEHP account, navigate to the Provider Directory menu, select the patient’s Network, and look for the "Compare Prescription Costs" tab.


Please encourage your patients to use this tool as well to find lower-cost medication options. 

Compare Prescription Costs

How to view Explanation of Payment (EOP) in the New Provider Portal



  1. Login to the New Provider Portal.
  2. From the home screen, click Office Management » Communications Archive from the navigation menu. 
  3. In the Provider Documents screen, start typing the name of the provider in the Select Provider box. Make sure to select the provider entry with the Supplier number that begins with "S" (not the Supplier Location [SL] or Practitioner [P] number). 
  4. Choose EOP from the Document Type drop-down, then input a date or date range and press the Search button 
Download Provider User Guide

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 the New Portal. 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

801-419-3699

cammie.keim@pehp.org

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