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A PEHP Provider Relations PUBLICATION
SUMMER 2011
New
New
DirectOR,
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New Directo
t Loftis
PEHP R. Che
int
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ded to
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ays of
find better w
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that doesn’t
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,
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r PEHP.
members, o
Inside
MORE UseFUL News
& information for
provider partners
Direction
Get acquainted
with some of the
new faces at PEHP
Enhancing
online
services
» PAG E S 4 - 5
» PAG E S 6 - 7
Provider News
In this
issue
2-3 R. Chet
Loftis, new
Group Insurance
Director
3 Healthcare
Reform
4-5 PEHP
Greetings and
Introductions:
Rodriguez, Chu,
Olsen & Tolley
6 Rejection
Reports
6 ICD-10 Code
Sets
7 Electronic
Funds Transfer
Improvements
7 Electronic
COB Claims
7 Fee Schedule
Enhancement
8 Preferred
Drug List
Changes
9 Changes
to PEHP PreAuthorization
List
10 Robotic
Surgery Policy
10 Medco
Health Physician
Service Center
Helpline
10 Customer
Service Calls
11 Provider
Relations
Representatives
12 Contact List
PAGE 2
PEHP Introduces R. Chet Loftis, Group Insurance Director
‘We Are All In
Director of PEHP
is ‘Problem Solver’
P
EHP welcomes R. Chet Loftis
as Group Insurance Director.
Chet brings a wealth of experience
in healthcare, government, and
the private sector together with
a broad skill set in law, public
policy, and management. He has
worked for all three branches of
state government.
“Chet is a problem solver with
20 years of experience who
understands the challenges in
healthcare and the importance
of making the system better,”
said Robert Newman, Executive
Director of Utah Retirement
Systems. “I’m confident he’s the
right leader for PEHP.”
Chet received his bachelor’s
degree, master’s degree in public
administration, and law degree,
with honors, from BYU. He
has been the Director of Public
Policy for Regence BlueCross
BlueShield of Utah, Vice-President
and General Counsel for the
Utah Medical Association, and a
shareholder with the Law Firm of
Kirton & McConkie.
Chet will be responsible for all
operations within PEHP, with
a focus on positioning PEHP to
adjust to the changing market
that healthcare reform requires.
Jeff Jensen will remain a key part
of PEHP’s management team,
focusing on day-to-day operations.
Message From Chet:
‘O
ur community is fortunate
to have such capable and
dedicated healthcare
professionals. All it takes is a diagnosis of a
life-threatening illness, a serious accident,
the upcoming birth of a child, or just a
confirmation that everything is OK to
appreciate just how excellent our community
of healthcare professionals is, and how good
we have it, especially here in Utah.
None of this happens by chance. It takes
a great deal of training, experience, and a
commitment to excellence. It takes people
who not only know what they are doing but
who also take pride in knowing that they are
making our community and our lives better
by what they do every day.
There are a lot of uncertainties about where
healthcare is going. Federal reform is on track
to expand access to the uninsured in 2014 by
subsidizing moderate income individuals
through Exchanges and permitting
significantly more low-income individuals
to qualify for Medicaid. This expansion of
coverage will only bring more focus and
greater attention to the problem of escalating
costs of healthcare.
Many believe that this government-funded
expansion, in conjunction with the mounting
national deficit, will inevitably lead us to a
single-payer system as the easiest and most
immediate way to control costs. Our hope is
that there are other, better ways to address
costs and that, frankly, we can develop and
implement them here in Utah.
Of course, the truth is that our payment
system doesn’t work very well for any of us.
1. It doesn’t work very well for you because:
a. it is costly and overly complicated to
administer.
Provider News
This Together’
Healthcare
Reform
Changes
For All
Groups
F
ederal
Healthcare
Reform will
bring changes
for all of our
groups.
b. it only pays you for some of the things
you do but not others.
whether they fully understand it or
not.
c. it can often get in the way of you doing
what you feel is best for a patient’s
health and well-being.
4. It doesn’t work very well for employers
who are increasingly finding it difficult to
fund the system because:
2. It doesn’t work very well for us because:
a. they will have more reasons to
consider getting out all together when
federal reform goes into full effect in
2014.
a. it is costly and overly complicated to
administer.
b. it creates incentives that reward
utilization rather than quality and
outcomes.
3. It doesn’t work very well for patients
because:
a. they often get caught in the middle of
payment disputes.
b. they ultimately end up paying for the
system through taxes, employment
compensation, and their wallet,
Ultimately, we have to figure how to make
the payment system work better for all of
us.
Over the years, I have been on just about
every side of healthcare. I have seen us
do some great things, and have every
confidence that together we can do so
again.
The State of
Utah risk pool
has sought
“grandfathered”
status and will
retain many
of the same
benefits of its
current plan.
Specifically,
members in
this group will
continue to
have a copay
for preventative
services. The
rest of our
groups have
not sought
“grandfathered”
status and will
not have copays
for preventative
services.
We encourage
provider offices
to verify benefits
to identify the
differences
between our
“grandfathered”
and “nongrandfathered”
plans.
Thanks again for all you do and for
making lives better.”
PAGE 3
Provider News
&
PEHP Welcomes ...
Greetings
Introductions
L
aurel Rodriguez joins PEHP’s Provider
Relations Department as a Provider
Relations Specialist with
responsibility for Service
Area #3 (see page 11).
DID YOU
KNOW?
One of the key
ways PEHP is
fighting fraud
is through
anonymous
reporting.
Both providers
and members
may submit a
confidential
and anonymous
report by
clicking on
the General
Information
section of
www.pehp.
org. You can
also generate a
report by calling
PEHP’s 24-hour
confidential
hotline at 888475-8376.
PAGE 4
She brings an extensive
background in the
provider community. This
includes medical software
support and ancillary
services, and surgery
center and medical group management.
She also was previously employed as a
licensed health & life insurance agent.
Laurel has served as an active member
on several boards and committees in the
healthcare community, including the
Utah Medical Association’s Third Party
Relations Committee, Utah Ambulatory
J
oan Chu, Certified Case Manager
(CCM), recently joined PEHP as Case
Management Manager
in our Clinical Services
Department.
Joan received her RN
degree in Florida and
later graduated with
a BS in Healthservice
Administration from
Weber State.
Joan’s nursing career began in Florida and
resumed in Utah at TriWest/Hill Air Force
Base, where she entered the managed care
arena of pre-authorization, utilization
review and case management. She was
employed at Hill AFB for seven years.
HELLO
Laurel
Rodriguez
is
my name
t
ons Specialis
Provider Relati
Surgery Center Association, Association
of Otolaryngology Administrators,
and a local Medical Insurance Practice
Management Advisory Committee.
Laurel is a native Utahn who returned to
Utah because of the great outdoors. She
enjoys golfing, hiking, playing classical
guitar, and traveling.
HELLO
is
my name
Joan Chu
ent Manager
Case Managem
Prior to her employment at PEHP, Joan
worked for five years in the Quality
Department of Davis Hospital, focusing on
performance improvement, data analysis,
and core measures.
Joan likes to read and travel. Before coming
to Utah she spent a year in Singapore.
Provider News
No Name Tag Required From Now On.
Now You Can Put a Face to the Name
K
rista Olsen, Certified Public
Accountant (CPA), has joined PEHP
as Director of Financial
Assurance.
A graduate of California
Polytechnic State
University, San Luis
Obispo with a BS in
Accounting, Krista has 20
years of experience in the
accounting and finance
field. She served as an Audit Manager
at KPMG Peat Marwick LLP, Finance
Manager at Iomega Corporation, and
lastly, as the Corporate Controller at Blue
Source LLC.
Krista is responsible for PEHP’s Fraud
T
ravis Tolley, formerly PEHP’s Clinical
Pharmacist, recently accepted the
position of Pharmacy
Director in PEHP’s
Clinical Services
Department.
Travis graduated from
Midwestern University
in 2001 with a Doctor
of Pharmacy degree.
Before joining PEHP, he
worked for Intermountain Health Care
as an Inpatient Staff Pharmacist at both
Cottonwood and LDS Hospitals and later
at Intermountain Medical Center.
Travis is a Board Certified
Pharmacotherapy Specialist with broad
knowledge and experience in internal
medicine, adult oncology, neonatal
HELLO
is
my name
Krista
Olsen urance
ancial Ass
Director of Fin
Investigative Unit, which addresses
member and provider fraud and abuse
cases. She is also accountable for
payment recoveries, subrogation, and the
internal audit of PEHP’s work processes.
Krista enjoys spending time outdoors
walking and hiking with her two very
spoiled dogs.
HELLO
Travis
Tolley
is
my name
ctor
Pharmacy Dire
intensive care, women’s services, inpatient
psychiatry, neuro-rehabilitation, formulary
management, and retail pharmacy. His
knowledge has proven to be an invaluable
resource to our organization, our networks,
and our members.
Travis enjoys fly fishing, golfing, hunting,
and whitewater rafting.
DID YOU
KNOW?
Your periodic
verification
of provider
information in
PEHP’s Provider
Lists via www.
pehp.org will
help ensure that
your patients
or future
patients will
not be misled.
If information
is incorrect,
please inform
your Provider
Relations
Representative.
PAGE 5
Provider News
Unsolicited Claims Response
Rejected Claims
Tagged 277FE
W
hen PEHP receives the 837 Electronic
Claim, we verify the information is
valid before it is submitted to our adjudication
system. If we can’t validate the claim, it
is rejected and a 277FE Unsolicited Claim
Response is sent back to the provider (Trading
Partner).
This 277FE Claim Response will indicate with
the appropriate response codes which claims
were accepted and which were rejected. These
codes are Health Care Claim Status Codes which
can be obtained from Washington Publishing.
If you are not receiving a 277FE and are
downloading your EDI transactions from UHIN
using the UHIN tool, please contact UHIN for
more information on how to obtain your 277FE.
If you are not receiving a 277FE and are using
a billing service or clearing house to send
and receive EDI transactions, please contact
either the billing service or clearing house for
assistance in addressing this issue.
Why Are Claims Rejected?
The most common reason claims
are rejected is because of a missing
or invalid:
» Member ID number
» Patient Name
» Patient Date of Birth
» Provider NPI
or
because the provider is not set
up in our EDI system under the
provider Trading Partner Number.
Code Sets
Planning is Key to ICD-10 Switch
W
DID YOU
KNOW?
If you misplaced
or forgot your
password to
login to PEHP’s
secure website,
your Provider
Relations
Representative
can help you.
PAGE 6
here are you on the compliance
timeline of ICD-10 implementation?
ICD-10 (International Classification of
Diseases, 10th edition) will replace the
current ICD-9 code sets that are used to
report healthcare diagnoses and procedures.
These changes have been mandated by
the Health Insurance Portability and
Accountability Act (HIPAA) and will be
effective Oct. 1, 2013.
In conjunction with the conversion from
ICD-9 to ICD-10, PEHP is on track to meet
the Dec. 31, 2011 deadline for converting to
Version 5010.
Early planning and preparation will make
the transition from ICD-9 to ICD-10 much
smoother for everyone. The assessment of
the needs of your office (as it relates to the
transition to ICD-10) should already be in
progress.
But, it is not too late! We encourage you
to speak with your practice management
vendor or clearinghouse to determine what
they are doing to prepare for this change.
AAPC.com is an excellent guide in the
implementation of the ICD-10 and an online
resource available to all providers, including
those without a practice management
vendor or clearinghouse.
Please note that after Oct. 1, 2013, claims
improperly coded with ICD-9 will not be
paid by PEHP.
Provider News
Online Services
EFT Improved to a New Level
N
o more checks. No more deposit slips.
No more worries of lost or stolen
checks. No more trips to the bank.
Did you know that PEHP offers Electronic
Funds Transfer (EFT)? This allows payments
to be deposited directly to your bank account
allowing direct access to your funds.
If you have not applied for EFT, it’s an easy
process! You need to:
» Have a UHIN Trading Partner Number
(TPN) – Contact UHIN at 801-466-7705
to obtain a TPN;
» Be currently sending electronic claims
(837) to PEHP;
» Obtain the EFT form at pehp.org under
the Providers section, or you may contact
your Provider Relations Representative
to obtain the form.
If you are or will be utilizing EFT, you have
two remittance types for reconciliation of
claims. They are:
» EFT payment with 835 Electronic
Remittance Advice, which enables
Submit Electronic Claims
Y
ou now can submit the EOB
electronically from the primary
carrier to be received by PEHP.
There is an abundance of benefits
associated with sending your claims
electronically, especially your COB
claims. They include:
» Receiving reimbursement quicker.
» Reducing your receivables backlog.
» Eliminating slow manual processes
and errors.
» Producing clearer and more precise
claims data.
Experiencing problems or have
questions? Call UHIN at 801-466-7705
or PEHP at 801-366-7544.
receiving and loading of the remittance
advice through the provider’s practice
management system;
or
» EFT payment with PDF file download,
which allows providers to download the
PDF file from the PEHP website, if they
are unable to receive and/or load the 835
file. This option requires provider login
access to the PEHP secure website and
office email address to send notification
of deposit to the bank account.
If you’re currently utilizing EFT
payment with 835 Electronic
Remittance Advice and
wish to change to the
PDF option, please
contact the PEHP EDI
Helpdesk at 801-3667544 to make the change.
If you do not have a super
user ID and password, see
the Did You Know on the
right.
Enhanced Fee Lookup Tool
R
eady to go back in time? PEHP’s
enhanced online fee lookup tool is
not a time machine, but it now allows you
to aquire the current and previous year’s
fees.
Utilizing this tool enables you to:
» Access fees for dates of service back to
April 15, 2010.
» Check the allowable for up to 10
separate codes or an unlimited range
of codes at one time.
» Obtain the allowable for each PEHP
network in which provider is
participating.
» Upload the current fee schedule to an
excel spreadsheet.
The fee schedule lookup tool is available
through PEHP’s secure website.
DID YOU
KNOW?
If you have
never obtained a
superuser name
and password
allowing you
access to member
eligibility, claims
status, benefit
limits, and code
rationale, go
to www.pehp.
org and click
on Providers /
Online Services
to obtain and
execute an
Electronic
Trading Partner
Agreement
(ETPA).
PAGE 7
Provider News
Pharmacy
Let Us Help Guide Your Pharmacy Choices
he PEHP Preferred Drug List helps
members and providers choose the
most effective and economical medication.
T
safety, efficacy, side effect profile, adverse
reactions, therapeutic category, and cost
effectiveness.
PEHP has created a Pharmacy and
Therapeutics Committee comprised of
local physicians, nurses, and pharmacists
to help manage the PEHP formulary.
This committee will review brand name
and generic drugs on a quarterly basis to
ensure PEHP’s Preferred Drug List contains
medications that provide our members
with the best overall value based on
The committee’s recommendations will be
implemented twice a year (January and
July) to help guide our members to the safest
and most effective therapy while helping to
manage the rising cost of pharmacy.
DRUG NAM
E
FORMULAR
Y
CHANGE
ACCOLATE
PEHP members
rely on the
accuracy of
the provider
information
on our online
Provider
Directory. That
is why it’s
important that
you inform us
whenever any
of your practice
information
changes.
Please contact
your Provider
Relations
Representative
to update your
provider file.
PAGE 8
Non-preferre
ADVICOR
DID YOU
KNOW?
ANTABUSE
AZELEX
CILOXAN OI
NTMENT
CONCERTA
FEMARA
HUMATROPE
KOMBIGLYZ
E XR
KRYSTEXXA
LOTREL
ONGLYZA
ORTHO TRI-C
OXYTROL
PRISTIQ
PROTONIX
QUIXIN
RYTHMOL SR
SUBUTEX
TRAVATAN Z
XGEVA
d (Tier 3)
Non-preferre
G
NEURONTIN
d (Tier 3)
Non-preferre
ARICEPT
5MG AND 10
M
CLIMARA
Below are the most
recent changes.
SOLUTION
YCLEN LOW
Non-preferre
d (Tier 3)
d (Tier 3)
Non-preferre
d (Tier 3)
Non-preferre
Non-preferre
d (Tier 3)
d (Tier 3)
Non-preferre
Non-preferre
d (Tier 3)
Not Covered
d (Tier 3)
Preferred (Tier
FORMULAR
Y
ALTERNATIV
E
zafirlukaast
SIMCOR
disulfuram
donepezil
FINACEA
VIGAMOX
estradiol patch
es
methylphenid
ate er
letrazole
NORDITROPI
N, GENOTROP
2)
IN
Specialty
Non-preferre
d (Tier 3)
Non-preferre
d (Tier 3)
Preferred (Tier
2)
Non-preferre
Non-preferre
d (Tier 3)
Non-preferre
d (Tier 3)
Non-preferre
d (Tier 3)
d (Tier 3)
Non-preferre
Non-preferre
d (Tier 3)
d (Tier 3)
Non-preferre
Non-preferre
d (Tier 3)
Specialty
d (Tier 3)
amlodipine/ben
azepril
gabapentin so
lution
trinessa, tri-pre
vifem
oxybutynin er,
venlafaxine er,
pantoprazole
DETROL LA
CYMBALTA
propafenone sr
buprenorphin
e
LUMIGAN, lat
anoprost
Provider News
Pharmacy
Always Remember to Check the List
P
EHP chooses specific prescription drugs
and specialty medications to require preauthorization. These specific prescription drugs
and specialty medications are chosen because of:
(a) the high potential for adverse reactions,
contraindications, misuse, and safety issues;
Drugs ADDED to
PEHP’s Pre-Authorization List:
DRUG
NAME
ABSTRAL
(b) the opportunity to use first line therapy;
(c) cost.
FORTESTA
Questions? Contact your Provider Relations
Representative or call PEHP Customer Service
at 801-366-7555 or 800-765-7347. Members may
call PEHP Customer Service for status of the
provider’s request.
Approval or denial will be communicated to
the provider’s office. Pre-authorization does not
guarantee payment and coverage is subject to
eligibility, benefit coverage, and pre-authorization
requirements.
HALAVEN
EFFECTIVE
DATE
April 15, 2011
BUTRANS
CAMPTOSAR
To begin, get pre-authorization forms at
www.pehp.org. Choose Providers/Provider Login
and enter your superuser ID and password.
HCPCS
CODE
April 15, 2011
J9206
March 15, 2011
April 15, 2011
C9280
Jan. 1, 2011
PROVENGE
C9273, Q2043
Feb. 1, 2011
TAXOL
J9265
March 15, 2011
TAXOTERE
J9171
March 15, 2011
KRYSTEXXA
Feb. 15, 2011
TRAVATAN Z
July 1, 2011
Drugs REMOVED from
PEHP’s Pre-Authorization List:
DRUG NAME
EFFECTIVE
DATE
ADAPALENE CREAM, GEL
Feb. 15, 2011
AMITIZA
April 1, 2011
AMPHETAMINE SALT COMBO
Feb. 15, 2011
APOKYN
Feb. 15, 2011
CHANTIX
July 1, 2011
DEXMETHYLPHENIDATE
Feb. 15, 2011
DEXTROAMPHETAMINE
Feb. 15, 2011
DIFFERIN CREAM, GEL, SOLUTION
Feb. 15, 2011
METHYLPHENIDATE, ER, SR
Feb. 15, 2011
ed D
r
r
e
f
e
r
P
PANRETIN
Feb. 15, 2011
PRISTIQ
July 1, 2011
SELZENTRY
Feb. 15, 2011
list of
a brief
This is
ations
n medic mplete.
commo
e co
y not b
and ma
THALOMID
July 1, 2011
ULORIC
April 1, 2011
Provided on the right are listings of new
medications that have been added or removed
from PEHP’s pre-authorization list. When
applicable the HCPCS-code is included.
t
rug Lis
Spring
2011
www.pehp.org
PEHP’s Preferred Drug List
is updated several times a
year and contains the most
current pre-authorization list,
in addition to other lists that
affect pharmacy choices. Find
it at www.pehp.org.
DID YOU
KNOW?
PEHP’S Case
Managers help
members find
economical ways
to meet their
needs without
compromising
quality of care.
PAGE 9
Provider News
Looking Out for Members
Robotic Assist Adds Cost
T
he use of robotic
technology in surgery
has evolved as a method to
assist surgeons with several
procedures. PEHP wants to
make sure our members and
providers are aware of our
reimbursement policy for
procedures performed with
the robotic-assisted technique.
When a surgical procedure
is performed using
robotic-assisted technique,
additional professional
or facility reimbursement
will not be made for the
robotic-assisted technique.
The reimbursement will be
based on the reimbursement
for the standard surgical
procedure(s).
Any additional charges
directly related to the use
of robot assistance will
be denied as member
responsibility. The addition
of modifier 22 is not
appropriate if the sole
purpose of the modifier is
to indicate the use of the
robotic-assisted technique.
We encourage our providers
and members to discuss the
most appropriate surgical
options.
Customer Service
Answers to Your
Questions a Call Away
T
DID YOU
KNOW?
WeeCare is a
free program
to support and
educate PEHP
expectant
mothers so
they will have
a safe, healthy
pregnancy. For
information,
go to www.
pehp.org or
www.health.
utah.gov/rhp/
weecare.
PAGE 10
he Medco Health Physician Service Center
Helpline is dedicated exclusively to
practicioners and their office staff. Calls related to
your patients’ prescription drug plan are addressed
by experienced Customer Service Representatives.
They will respond to questions or concerns
immediately. They’re interested in any feedback
that you may have for Medco Health.
The Physician Service Center at 800-211-1456 is
available from 6 a.m. to 6 p.m., Monday through
Friday. When you leave a message after hours, your
call will be returned the next business day. If you
have previously been given a number to call for a
specific Medco program, you should continue to
call that number directly.
The Physician Service Center can answer general
questions such as:
» Is this drug covered under my patient’s
formulary?
» Does this drug require pre-authorization or
review?
» What is the status of my patient’s prescription?
» How does Medco Health’s Home Delivery
Pharmacy Service work?
Exceptional
on the phones
P
EHP’s Customer Service
Department is committed
to ensuring that callers
get accurate and reliable
information.
To help maintain this
commitment of excellent
service, a percentage of calls
are randomly audited.
A 96% accuracy rating from all
representatives is required.
For May 2011, their average
was 98.29%.
Provider News
Provider Relations Representatives
To provide optimal service to PEHP providers, each Provider Relations Representative is assigned a specific area
to manage. This assignment is based on the physical locations of the providers. If you are unsure who your
representative is, please call PEHP at 800-365-8772 or 801-366-7700.
SERVICE AREA #1
SERVICE AREA #2
Chantel Lomax
Provider Relations Specialist
Wendy Philbrick
Provider Relations Specialist
Phone: 801-366-7507 or 800-753-7407
Fax: 801-245-7507
E-mail: [email protected]
Phone: 801-366-7753 or 800-753-7753
Fax: 801-245-7753
E-mail: [email protected]
In-State Cities
Draper (84020), Holladay (84117, 84121 & 84124),
Salt Lake City, Sandy (84070, 84090, 84091, 84092,
84093 & 84094)
In-State Counties
Box Elder, Cache, Davis,
Morgan, Rich, Summit,
Weber
Out-of-State
Colorado
Out-of-State
Arizona, Idaho
SERVICE AREA #3
SERVICE AREA #4
Laurel Rodriguez
Provider Relations Specialist
Glenda Lowe
Client Liaison
Phone: 801-366-7721 or 800-753-7721
Fax: 801-245-7721
E-mail: [email protected]
Phone: Fax: E-mail: In-State Counties
Carbon, Daggett,
Duchesne, Emery, Juab,
Millard, Sanpete, Tooele,
Uintah, Utah, Wasatch
Out-of-State
Wyoming
In-State Cities
Herriman (84065 & 84096),
Kearns (84118), Magna
(84044), Midvale (84047),
Riverton (84065, 84095
& 84096), South Jordan
(84065 & 84095),
Taylorsville (84084, 84118
& 84119), West Jordan
(84084 & 84088),
West Valley (84117, 84119,
84120 & 84128)
In-State Cities
Murray (84107, 84123 &
84157)
801-366-7496 or 435-673-6300
or 800-950-4877
435-634-0654
[email protected]
In-State Counties
Beaver, Garfield, Grand,
Iron, Kane, Piute,
San Juan, Sevier,
Washington, Wayne
Out-of-State Cities
Las Vegas, Nevada
Mesquite, Nevada
SERVICE AREA #5
MAILING ADDRESSES
Selena Johnson
Provider File Technician
Service Area #4
Glenda Lowe
Phone: 801-366-7511 or 800-753-7311
Fax: 801-245-7511
E-mail: [email protected]
URS/PEHP
166 North 100 East #9
St. George, UT 84770
Out-of-State
All states other than those listed above
All Other Service Areas & Representatives
PEHP
560 East 200 South
Salt Lake City, UT 84102
PAGE 11
PRESORTED STANDARD
U.S. POSTAGE PAID
SALT LAKE CITY, UTAH
PERMIT NO. 4621
560 East 200 South | Salt Lake City, UT 84102-2004
Provid r N ws
A PEHP Provider Relations PUBLICATION
SUMMER 2011
Contact List
Please note: The contact numbers for Prenotification and Customer Service are not the same.
PEHP Waist Aweigh Program
. . . . . . . . . . . . . . . . . . . . . . . . . 801-366-7478 or 800-753-7478
Customer Service/
Health Claims Information
Provider Relations
. . . . . . . . . . . . . . . . . . . . . . . . .801-366-7555 or 800-765-7347
Glenda Lowe . . . . . . . . . . . .801-366-7496 or 800-950-4877
Client Liaison
[email protected]
EDI Helpdesk
. . . . . . . . . . . . . . . . . . . . . . . 801-366-7557 or 800-677-0457
. . . . . . . . . . . . . . . . . . . . . . . . .801-366-7544 or 800-753-7818
Chantel Lomax . . . . . . . . . . 801-366-7507 or 800-753-7407
Provider Relations Specialist.
[email protected]
Inpatient Medical Pre-notification
and Benefits for I/P Admit,
I/P Rehab, or SNF
Laurel Rodriguez . . . . . . . .801-366-7721 or 800-753-7721
Provider Relations Specialist [email protected]
Inpatient Mental Health
& Substance Abuse Authorization
Selena Johnson . . . . . . . . . 801-366-7511 or 800-753-7311
Provider File Technician
[email protected]
Health Claims Information. . 801-366-7755 or 800-753-7754
Blomquist Hale Consulting Group (BHCG)
Canyons School District
Jordan School District
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 801-262-9619 or 800-926-9619
Mental HealthCare of Utah (MHCU)
All other employer groups
. . . . . . . . . . . . . . . . . . . . . . . . .801-293-7400 or 800-541-9432
7/19/11
Wendy Philbrick . . . . . . . . . 801-366-7753 or 800-753-7753
Provider Relations Specialist [email protected]
Beryle Bird . . . . . . . . . . . . . .801-366-7795 or 800-753-7595
Provider Relations Analyst
[email protected]
Cortney Larson . . . . . . . . . 801-366-7715 or 800-753-7715
Director of Provider Relations
[email protected]
PEHP Website
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.pehp.org