Dear Provider:

Peach State Health Plan’s (Peach State) policy requires that elective procedures are performed at the most cost effective level of care to ensure safety and to achieve the best health outcome for our members. In an effort to meet this goal, May 1, 2011 Peach State is making some important changes to our Prior Authorization requirements. We are pleased to announce that in direct response to our Provider requests, Peach State’s Prior Authorization (PA) listing is now available on Peach State’s website, www.pshp.com. This enhancement will provide you with on-line, real-time access to the most recent updates to prior authorization services and procedures by CPT code and place of service. In addition, the Prior Authorization Guide has been updated. For additional information, visit the Utilization Management section of the Provider Resource page.

• Authorization Requirement – requests for routine/elective procedures should be submitted for authorization at a minimum of 5 business days prior to initiating the service or procedure. Please Fax completed requests to (866) 532-8834.

• No Authorization Required – an authorization is not required when medically necessary covered Procedures (excluding Cosmetic & Bariatric Procedures) & Diagnostic services are performed by participating providers at participating Ambulatory Surgical Centers.

• Urgent Requests and Admission Notifications – for urgent requests and admission notifications, please call (800) 704-1483.

Peach State’s Utilization Management Department hours of operation are Monday through Friday (excluding holidays) from 8:00 a.m. to 5:30 p.m. For Urgent Requests and Admission Notifications, please call (800) 704-1483.

As always, we thank you for the excellent care you provide to our members.

Sincerely,

Utilization Management

Peach State Health Plan

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