July 1, 2009

RE:  PPS Payments to FQHCs and RHCs

 Dear Provider:

 This is a follow-up notification to Peach State Health Plan (Peach State)  past mailing regarding mandated revisions to the State of Georgia, Department of Community Health (“DCH”) payment methodologies for FQHCs and RHCs.

 Pursuant to the Amended Agreement between The State of Georgia, Department of Community Health (“DCH”) and Peach State Health Plan, Peach State shall include in its Provider network all FQHCs and RHCs in its Service Region based on PPS rates effective July 1, 2008.

 The equivalent all-inclusive PPS payment rates shall represent a full replacement of your current contracted rates; and all clean claims with dates of service beginning on July 1, 2008 and thereafter, shall be paid at least at the DCH mandated PPS rates.

 Beginning January 1, 2009, DCH ceased making wrap payments to FQHCs and RHCs.  As a result, Peach State is required to reconcile paid claims from dates of service on January 1, 2009 and beyond to equal your current PPS rates; and is required to pay all new, clean claims at the your current PPS rates.

 For the period of July 1, 2008 to December 31, 2008, where DCH continued to make wrap payments to FQHC and RHCs, the PPS reconciliation shall be handled in a separate process. Peach State will work closely with DCH and your organization to assure your claims have been paid properly at the then current PPS rates.

 Finally, our records indicate that your organization has not returned your executed Amendment/Agreement that reflects the PPS payment revisions.  For recordkeeping purposes, please return your executed documents no later than July 15^th, 2009. In any event, your current rates will be fully replaced with PPS rates as noted above and they shall be implemented in our claims system no later than July 30, 2009.

 Please return both original executed Amendments/Agreements to:

 Attention:  Director

Contracting and Network Development

Peach State Health Plan

3200 Highlands Parkway SE

Suite 300

Smyrna, GA 30082

One original executed Agreement will be returned later for your records.  Should you have any questions regarding this communication, please call Peach State at 866-874-0633.

Sincerely,

Peach State Health Plan

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