Once you are approved for Medicaid or PeachCare for Kids you must enroll with Georgia Families. Peach State Health Plan offers health insurance plans that fit your unique needs. The Care Management Organizations that contracted with Department of Community Health during SFY 20222023 are displayed in Table 2-1. State of Georgia government websites and email systems use "georgia.gov" or "ga.gov" at the end of the address. Centene was founded in 1984. We look forward to working with you to improve the health of the community. Amerigroup Community Careis a wholly-owned subsidiary of Amerigroup Corporation, the nation's largest company solely focused on low-income families and people with disabilities. How you know. You can also view more information about Peach State Health Plan in our Member Handbook. Four ways to choose Peach State Health Plan: Once you pick Peach State Health Plan, we will send you a letter telling you when you can start using your new services. Youll get a renewal note in the mail before the deadline. You will need Adobe Reader to open PDFs on this site. Thank you for your interest in participating in the network for Peach State Health Plan. Product lines include Medicaid, Medicare commercial, federal employees, and specialty services. Effective 12/1/2015, The Georgia Department of Community Health (DCH) will require all Medicaid providers seeking to enroll in the Peach State Health PlanProvider Network or any other CMO network to be credentialed and re-credentialed by the centralized Credentialing Verification Organization (CVO). Backed by our parent company, Centene Corporation, Peach State draws on financial stability and national expertise to deliver local services and programs. The Department of Community Health employs a care management approach to organize its system of care, enhance access, achieve budget predictability, explore possible cost containment opportunities, and focus on systemwide performance improvements. Or call Provider Services at 1-866-874-0633 Monday-Friday, 7 a.m. to 7 p.m. We are closed on holidays. Were here for you and your family and will do everything we can to support you. 3. Someone from Peach State Health Plan will contact you about your message. been Medicaid-eligible or unable to access care due to financial challenges. Youll need to confirm your income when you renew. How do I know if I am in the right place? All services must be medically necessary. Local, state, and federal government websites often end in .gov. CareSource-Brand-Logo-Vert-RGB-resize.png. Speech and hearing services. If you do not have an internet connection, contact HPES Provider Enrollment at 1-800-766-4456, press option #0 for the main menu and then press option #6. Depending on your family size and income, you may even qualify for help to pay your monthly premium. An official website of the State of Georgia. Ambetter offers affordable health care coverage for individuals and families. Sleep Studies. Sort Results By Sort Results By. Try to take moments to breathe and be kind to yourself. Therefore, it will also be necessary for you to submit a credentialing application to the CVO prior to your acceptance in to our Provider Network. Obtaining medical equipment To provide the necessary non-emergency medical transportation, DCH utilizes a brokerage system and it is these two Brokers, Modivcare Solutions (formerly LogistiCare) and Verida (formerly Southeastrans), who coordinate and provide NEMT services for the state's five regions (North, Atlanta, Central, East and Southwest). Amerigroup Community Care is a subsidiary of Amerigroup Corporation. Amerigroup is a wholly owned subsidiary of Anthem, Inc., founded in 2004 with the merger of Anthem and WellPoint Health Networks. Local, state, and federal government websites often end in .gov. Our call centers are experiencing intermittent technical issues and may be delayed in answering your call. We encourage you to log into your secure account where many of your questions may be answered. Get insured or become a provider today. Some covered services or medications may need approval from Peach State Health Plan, and this is called a Prior Authorization. "Confirm NPI Number" must be completed properly before submitting. Find a Medicaid Provider | Georgia Medicaid | Peach State Health Plan Find a Doctor Find a Doctor Start your search for a doctor, dentist, specialist, hospital, clinic, or pharmacy in our network. An official website of the State of Georgia. All services must be medically necessary. To learn more about Peach State: With a focus on health and wellness, the CMOs provide members with health education, prevention programs and expanded access to plans and providers, giving them the tools needed to live healthier lives. Medicaid Georgia FAMILIES Don't settle for basic Medicaid. Backed by our parent company, Centene Corporation, Peach State draws on financial stability and national expertise to deliver local services and programs. Product lines include Medicaid, Medicare, and the Exchange plans in some states. *Some Medicaid and PeachCare for Kids members may not have all the benefits listed. Local, state, and federal government websites often end in .gov. Medical Records 94. Peach State Health Plan's plan is called Ambetter. Georgia Medicaid members qualify for a free phone and plan via the federal Lifelineprogram. Georgia----- 183 Illinois . PDF Provider and Billing Manual - Ambetter from Peach State Health Plan Contact Peach State Health Plan CMO Toll Free: (866) 874-0633 https://www.pshpgeorgia.com/ Peach State Peach State. To request a package by mail or a visit by one of our Georgia provider representatives, call us at 1-800-249-0442. To learn more about CareSource, call 1-855-202-0729 or visit our website atCareSource.com/Georgia. "There will be far fewer uninsured folks as a result of this Medicaid renewal process in the. Before sharing sensitive or personal information, make sure youre on an official state website. Call us at1-800-704-1484(TTY/TDD 1-800-255-0056). Review the Medicaid Quality reports page for Quality Strategic Plans, Quality Performance Dashboards, and External Quality Review Organization Reports. Coronavirus disease 2019 (COVID-19) is an emerging illness. How you know. Review current Georgia Families and Georgia Families 360 contracts on the Georgia Families webpage. REGULATORY MATTERS 94. "Confirm Year of Birth" must be completed properly before submitting. Amerigroup is dedicated to offering Georgia Medicaid families and PeachCare for Kidsmembers the standard Medicaid benefits plus extra value-added services. "Confirm Practice / Clinic / Facility Name" must be completed properly before submitting. Select the program you are enrolled with. Per federal regulations, the Department of Community Health must periodically, but no less frequently than once every three years, conduct or contract for an independent audit of the accuracy, truthfulness, and completeness of the encounter and financial data submitted by, or on behalf of each Care Management Organization and post the results of these audits on our website. 42 CFR 438.602(e) and (g). Download the free version of Adobe Reader. On paper: Use the form you get in the mail from Georgia Families. For more information about Peach State or how to join our growing network of providers, call us at 1-866-874-0633 or visit our website at https . Peach State Health Plan provides the same benefits as Medicaid and PeachCare for Kids, plus more. Authorization for Cancer Treatment/New Century Health. An official website of the State of Georgia. Find a Medicaid Provider | Georgia Medicaid | Peach State Health Plan MAKE THE CHANGE TO CARESOURCE 1-877-423-4746 COVER WHAT MATTERS We get it. Peach State Health Plan Provider Portal & Resources | Peach State State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. CareSource proudly serves Medicaid and PeachCare for Kids members enrolled in the Georgia Families program. Rural Health Centers - The State Office of Rural Health (SORH) works to improve access to health care in rural and underserved areas and to reduce health status disparities. You can also call member services at 1-800-704-1484 (TTY/TDD 1-800-255-0056) Monday-Friday, 7 a.m. to 7 p.m. Or call Provider Services at 1-866-874-0633 Monday-Friday, 7 a.m. to 7 p.m.We are closed on holidays. Georgia Families is a partnership between DCH and private health plans (also called "care management organizations" or "CMOs") to provide benefits and health care services to Medicaid and PeachCare for Kids members, Planning for Healthy Babies (P4HB) enrollees, and Georgia Families 360 members. On January 23, 2020, WellCare Health Plans, Inc. became a wholly owned subsidiary of Centene Corporation. View claims, get a new ID card, update your information and more! Use the Find A Doctor Tool to search for in-network Medicare doctors, hospitals, pharmacies, and other providers. The State of Georgia introduced the Georgia Families managed care program in 2006 and contracts with private Care Management Organizations to deliver services to enrolled members. Medicaid Managed Care | Georgia Department of Community Health If you are a non-contracted provider, you will be able to register after you submit your first claim. It's easy for you to pick Peach State Health Plan. Coronavirus disease 2019 (COVID-19) is an emerging illness. . A Family planning program for women who do not qualify for Medicaid, or who have lost Medicaid coverage. Jul 13, 2023. You may also Contact Us. WellCare of Georgia, Inc., is a subsidiary of WellCare Health Plans, Inc. WellCare was founded in 1985. Authorization for Cancer Treatment/New Century Health, how you can keep yourself and your family healthy. Fee Schedules - Georgia Beginning April 1, 2023, all Georgia Medicaid and PeachCare for Kids members will undergo an eligibility review. To apply for Medicaid, please apply online https://gateway.ga.gov or in person at your local DFCS county office or or request an application by calling 877-423-4746. Provider Performance Monitoring and Incentive Programs 92. "Confirm Phone" must be completed properly before submitting. In-patient hospital care is provided at one of the hospitals associated with Peach State Health Plan. Provider Resources Use our helpful resources to deliver the best quality of care. Medicaid | Georgia - Medicaid | CareSource This joining of our organizations will allow us to become a more robust health plan and enhance the delivery of best-in-class care to our members. An official website of the State of Georgia. Peach State Health Plan(Peach State) is a physician-driven, Georgia-based Medicaid managed care plan. The Department of Community Health is the single State agency for Medicaid. Georgia is one of 10 states that has not fully expanded Medicaid under the Affordable Care Act. Georgia Medicaid Medical Assistance Plans To advance the health, wellness and independence of those we serve. How you know. Backed by our parent company, Centene Corporation, Peach State draws on financial stability and national expertise to deliver local services and programs. The provider performing the treatment or service will submit a request for authorization to the health plan along with medical information that supports the treatment. Peach State Health Plan licensed and trained staff members review all prior authorizations and pre-certifications. Members can visitwww.georgia-families.com or call888-423-6765to speak to a representative who can give them information about the CMOs and the health care providers. Find a Medicaid Doctor Finding a doctor is quick and easy. The State refers to its CHIP as PeachCare for Kids. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. Amerigroup 360 is a subsidiary of Amerigroup Corporation. Medical Records Release 96. In this section, you can learn about the health benefits, pharmacy services and value added services Peach State Health Plan offers. Welcome to Ambetter from Peach State Health Plan . Be sure to receive the services listed below from a Peach State Health Plan provider. Peach State Health Plan exists to improve the health of its beneficiaries through focused, compassionate & coordinated care. An official website of the State of Georgia. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Effective 12/1/2015, The Georgia Department of Community Health (DCH) will require all Medicaid providers seeking to enroll in the Peach State Health Plan Provider Network or any other CMO network to be credentialed and re-credentialed by the centralized Credentialing Verification Organization (CVO). https://www.myamerigroup.com/ga/georgia-home.html, Georgia Families Provider Quick Reference Guide, Georgia Families Quick Reference Pharmacy Guide, Georgia Families Enrollment Packet (Sample Copy Only), Georgia Families Frequently Asked Questions, Third Party Liability Services Procurement, Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Health Insurance Premium Payment Program (HIPP), 2020 Georgia Families 360 Monitoring and Oversight Committee, 2019 Georgia Families 360 Monitoring and Oversight Committee, Georgia Medicaid Electronic Visit Verification, PSS / CLS / Claims Implementation Archive (2018 2021), Georgia Money Follows The Person (Ga MFP), Infant and Early Childhood Behavioral Health Services, Medicaid Enterprise System Transformation (MEST), Non-Emergency Medical Transportation FAQs, Non-Emergency Medical Transportation (NEMT) Procurement, Planning for Healthy Babies Program Overview, Planning For Healthy Babies Annual Reporting, Planning For Healthy Babies Semi-Annual Reporting, Planning For Healthy Babies Quarterly Reporting, Planning For Healthy Babies Summative Evaluation Reporting, Right from the Start Medical Assistance Group. You can learn more about Amerigroup Community Care atwww.amerigroupcorp.com. Go Now Find a Medication View our Preferred Drug List to see what drugs are covered. 4. PDF PSHP - GA - Georgia Families Medicaid & PeachCare for Kids - Member Contact Us | Georgia Medicaid | Peach State Health Plan PeachCare for Kids An official website of the State of Georgia. For example. Use this tool to find doctors, hospitals, pharmacies and specialty providers in our network. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. PeachCare for Kids is an affordable health insurance for Georgia's uninsured children. Medical Records Transfer for New Members 96. For information on contracting as a health partner, call 1-855-202-1058 or visitCareSource.com/providers/Georgia. Provider News - In this section, youll find the latest news about the mandated transition to ICD-10 Code Sets, the Hospital Provider Payment Program, the ACAs mandates on rate increases for certain primary care practitioners, Centralized Credentialing for new Medicaid Providers, Medicaid Enrollment for Ordering, Prescribing and Referring Providers and on-going audits and reviews being conducted by DCHs Office of the Inspector General. Contact Medicaid Care Management Organizations (CMOs), File a Complaint about a Licensed Facility, File a Mental Health Parity Complaint Form, Facebook page for Georgia Department of Community Health, Twitter page for Georgia Department of Community Health, Linkedin page for Georgia Department of Community Health, YouTube page for Georgia Department of Community Health, Medicare Advantage Special Needs Plan Agreement - 2012, Medicare Advantage Special Needs Plan Agreement - 2013, Ground Ambulance (Public/Private) Providers, Patient Driven Payment Methodology (PDPM), Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC), Medicaid Sign-Up Portal (Georgia Gateway). By phone: Call 1-888-GA-Enroll (1-888-423-6765). Members can apply for this free benefit. Georgias Medicaid Management Information System (GAMMIS) is an integration of computer systems that process Medicaid and PeachCare for Kids claims and other pertinent information related to the management of the Medicaid and PeachCare for Kids programs. Before sharing sensitive or personal information, make sure youre on an official state website. The Department of Community Health is responsible for administering the Medicaid program and CHIP in the State of Georgia. Peach State Health Plan is a subsidiary of the Centene Corporation. Home Health, Dental, CIS/CISS and Other Providers. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Georgia Families | Georgia Medicaid If you are not enrolled with Peach State Health Plan, review Get Insured for more information. In-patient hospital services. How to Apply for Medicaid in Georgia | Peach State Health Plan Nursing Home Providers - Here youll find Cost Reports, Amended Cost Reports, Provider Fee Report forms for Medicaid and non-Medicaid nursing facilities, Fair Rental Value System information for net per diem reimbursements and more. The Department of Community Health must ensure, through its contracts starting on or after July 1, 2017, that each Care Management Organization calculate and report a MLR in accordance with 42 CFR 438.8. Learn about how you can keep yourself and your family healthy. Please fill out the below form. SFY 2023 Hospital Provider Fee Memorandum - Posted 06/15/22. Call us at 1-800-704-1484 ( TTY/TDD 1-800-255-0056 ). CareSource provides Medicaid and PeachCare for Kids members and Planning for Healthy Babies enrollees with extra help and benefits that go beyond health care. (Exception: No Prior Approval required when Sleep Study is performed in the home). Choose Peach State Health Plan. You can also download a provider contract at this web site. Georgia Healthcare Solutions | Centene Corporation In partnership with Georgia Families, Peach State will help educate both the Georgia Medicaid members and healthcare providers about the enhancements to the Medicaid and PeachCare for Kids programs. As a nonprofit, CareSource is dedicated to clearing a path to health and well-being through innovative products, programs and services. P4HB members renew every 12 months. Yes. Authorization for Cancer Treatment/New Century Health, How to Create Positive New Habits in our New World. You will need Adobe Reader to open PDFs on this site. The Georgia Department of Community Health (DCH) values all physician and health care provider contributions to the health and well-being of all Georgians. Georgia's Medicaid Management Information System (GAMMIS) is an integration of computer systems that process Medicaid and PeachCare for Kids claims and other pertinent information related to the management of the Medicaid and PeachCare for Kids programs. Source: Advantage Suite, 6/26/2023, HD;This report is based on Medicaid and Peachcare for Kids members in May 2023. Right now, nothing is changing. Members: call the number on the back of your ID card or go to the plan site. Certain diagnostics tests. Contact Georgia Medicaid | Georgia Medicaid Member Services: 1-800-704-1484 (TDD/TTY 1-800- 255-0056) Log on to: pshp.com. . Some diabetic supplies for insulin and blood glucose monitoring do not require authorization. Welcome. **Amerigroup 360 is not separately accredited from Amerigroup. *Accredited: NCQA has awarded an accreditation status of Accredited for service and clinical quality that meet the basic requirements of NCQAs rigorous standards for consumer protection and QI. Third Party Liability Services Procurement, Childrens Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Health Insurance Premium Payment Program (HIPP), 2020 Georgia Families 360 Monitoring and Oversight Committee, 2019 Georgia Families 360 Monitoring and Oversight Committee, Georgia Medicaid Electronic Visit Verification, PSS / CLS / Claims Implementation Archive (2018 2021), Georgia Money Follows The Person (Ga MFP), Infant and Early Childhood Behavioral Health Services, Medicaid Enterprise System Transformation (MEST), Non-Emergency Medical Transportation FAQs, Non-Emergency Medical Transportation (NEMT) Procurement, Planning for Healthy Babies Program Overview, Planning For Healthy Babies Annual Reporting, Planning For Healthy Babies Semi-Annual Reporting, Planning For Healthy Babies Quarterly Reporting, Planning For Healthy Babies Summative Evaluation Reporting, Right from the Start Medical Assistance Group.