Dear Peach State Provider:

Peach State Health Plan (Peach State) is committed to providing timely resources to assist you and your staff in delivering high quality and cost efficient care to Peach State’s members. Periodically, Peach State reviews its medical policies and practices for opportunities to enhance its services and programs. This letter is designed to notify you of available options for elective procedures and Ambulatory Surgery Centers (ASC).

Peach State’s policy requires that elective procedures are performed at the most cost effective level of care to ensure safety and best outcomes for our members. To help us achieve this goal, we ask that whenever possible, you consider utilizing an ASC (see the enclosed-Peach State Preferred ASC Listing) when performing qualifying outpatient procedures. A benefit to utilizing an ASC is that Peach State does not require prior authorization for procedures performed at ASCs (except for bariatric surgeries or surgeries of cosmetic nature). To assist you with making an informed selection, when contacting Peach State for precertification of a procedure, a representative will ask, if you would consider performing the surgery in an ASC.

Similarly, if an elective procedure requires an inpatient stay, you may be asked (at the time of the precertification request) if you would consider performing the procedure at a preferred nearby hospital.

Ultimately, the decision as to where the procedure is performed is yours.  However, please consider this cost effective alternative before deciding where to perform the procedures for our members. Peach State supports all decisions that ensure high quality outcomes.

Thank you for your consideration of this information.  As always we thank you for the excellent care you provide to our members.  For questions or concerns, call the Provider Solutions Department at 1-866-874-0633, Monday – Friday, 7am – 7pm.

Sincerely,
Peach State Health Plan

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