Peach State Health Plan Blog

Dear Provider:

Peach State Health Plan (Peach State) is pleased to announce that effective June 1, 2011, we have partnered with Univita Health, Inc., to provide Durable Medical Equipment (DME), Home Health and Home Infusion Pharmacy services to Peach State members.  

Peach State’s selection of Univita was made to ensure that Peach State’s members receive the most from their benefit plan, thus providing a positive impact on the member’s overall healthcare experience. 

In the coming weeks, you will be receiving information from Univita regarding Peach State members that are receiving DME, Home Health and Home Infusion Pharmacy services.   

In the meantime, please feel free to contact Provider Services at 1-866-874-0633, with any questions.  

Sincerely,

Peach State Health Plan

Provider Services Department

This entry is filed under News.

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

This entry is filed under News.

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

This entry is filed under News.

To support your commitment to provide quality care for your patients, Peach State Health Plan is offering a highly effective motivation and education plan called the Healthy Solutions for Life
program.

The Healthy Solutions for Life program is built on a comprehensive set of protocols based on standard and evidence-based guidelines from the American Diabetes Association, the American Heart Association, the American Lung Association, National Institutes of Health, and others.
These guidelines are available on request.

The Healthy Solutions for Life program will support your treatment plan as well as complement the care you provide. Our caring, experienced health coaches provide self-care education for optimal health and disease management. As the primary care provider and principal channel for patient contact, your support and input is essential in determining the services provided by the Healthy Solutions for Life clinical staff.

Peach State Health Plan and the Healthy Solutions for Life staff will identify members with a specifieddiagnosis who are eligible for the program. The identified member(s) will be enrolled in the program unless he or she declines. A health coach from the Healthy Solutions for Life Program may be contacting you regarding your patient(s) enrollment in or eligibility for the program, and how you can help promote healthy choices and behavior. I invite you to learn more about opportunities for patient health support from the Healthy Solutions for Life program.

I sincerely hope you agree that a partnership in wellness involving yourself, the Healthy Solutions for Life staff, and your patients affords the best and most cost effective care. For additional information, please contact the Healthy Solutions for Life staff at 1-800-303-2317. Office hours are from 9:00 a.m. to 9:00 p.m. ET.

Please click the links below for our  scope of service, contact information, and the Provider Rights statement.

Sincerely,
Dean Greeson, MD MBA

Provider Notification – Healthy Solutions for Life Program (PDF)

Healthy Solutions for Life Program – Frequently Asked Questions (PDF)

This entry is filed under News.

FOR IMMEDIATE RELEASE

Media Contact

Robert Clarke

404-446-1670

rclarke@duffey.com

–Funds will bolster access to pediatric care in Muscogee County region–

Columbus, GA (March 9, 2011) – To address the shortage of pediatric physicians in Muscogee County and surrounding areas, Peach State Health Plan (Peach State) will announce a $100,000 donation to Columbus Regional Healthcare System and The Medical Center at a March 9 event. The funds will be used to help establish a medical practice that will increase access to primary and pediatric care, primarily for those enrolled in the Medicaid program in the Columbus area.

“The limited access caused by the lack of pediatric physicians in the area can escalate chronic medical conditions into acute, emergency situations that result in unnecessary, costly strains on emergency departments,” says Dr. Dean Greeson, VP, Medical Affairs and Chief Medical Director at Peach State. “Peach State is uniquely positioned to step up and play a proactive role in providing Muscogee-area children greater access to health care services.”

The new practice – projected to open in spring of 2011 – will be on Columbus Regional’s main campus, which is centrally located and on city bus routes. The site is positioned near various specialists and ancillary care sites, including OB/GYN and diagnostic imaging.

“Considering the central location of the Columbus Regional campus, the practice is projected to accommodate approximately 23,000 annual patient visits by the third year of operation,” says Mike Hill, CEO of Evergreen Medical Group, a physician-hospital organization jointly owned by Columbus Regional and community physician partners. “Peach State’s donation will have a positive and lasting effect on Muscogee County and make a real difference to our region’s children and caregivers.”

Columbus Regional will recruit one physician and two mid-level pediatric-care providers. Plans are to recruit either a family practice physician with interest in newborns or a pediatrician. By not limiting the scope of the physician recruitment, the practice will be better positioned to meet the needs of the Muscogee County pediatric population as quickly as possible.

“Establishing a new medical practice open to patients who rely on Medicaid is among the most viable and expedient solutions to address pediatric care in the Muscogee County region,” says Patrick Healy, CEO of Peach State. “Peach State is committed to investing in the communities we serve, and this donation is a testament to our give-back philosophy.”

About Peach State Health Plan

Peach State Health Plan (Peach State) is a Care Management Organization that serves the Medicaid and PeachCare for Kids ^™ population in partnership with Georgia Families. Peach State is a wholly owned subsidiary of Centene Corporation, a leading multi-line healthcare enterprise offering both core Medicaid and specialty services. Information regarding Peach State is available via the Internet at www.pshp.com.

About Columbus Regional Healthcare System

Columbus Regional is a not-for-profit organization providing health, medical and educational services to west Georgia and east Alabama. Facilities and services include The Medical Center, Doctors Hospital, Hughston Hospital in Columbus and the John B. Amos Cancer Center. Columbus Regional has the region’s only advanced maternity services and neonatal intensive care unit, a dedicated pediatric service and pediatric critical care unit, a dedicated trauma center and highly regarded emergency services for children and adults. Information is available at www.yourhealthourmission.com.  

About Evergreen Medical Group

Evergreen Medical Group is a physician-hospital organization jointly owned by Columbus Regional and community physician partners. Evergreen contracts with payors on behalf of community physicians and Columbus Regional facilities and services. Information is available at www.evergreenmedicalgroup.com.

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This entry is filed under Blog, News.