To Register for Online Training:

1. Go to https://centene.webex.com
2. Select the Meeting Center Tab and register for provider portal training
3. Include your provider name in the Company Name field during the registration
4. Once you register you will receive an email with instructions on how to access the training session.

Please select the calendar below  for all  available training dates.

Webex Training Calendar (PDF)

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Dear Provider:

 Peach State Health Plan (Peach State) has partnered with PaySpan Health to offer you expanded electronic claim payment (EFT) services. 

Please note that as of June 15, 2009, all providers currently receiving electronic claim payments (EFT) through the Peach State Health Plan EFT Agreement will no longer receive this service from Peach State. Providers may instead receive EFT services through PaySpan Health, at no cost, upon registration with PaySpan Health EFT. Please be advised this letter serves as notification of termination of the EFT agreement between you and Peach State.

By signing up with PaySpan Health, a web-based application, providers may more quickly receive electronic claim payments and remittance advices (ERAs/EOPs) online. This service is available to Peach State providers immediately upon registration with PaySpan Health. To register, providers may call PaySpan Health at 1-877-331-7154, or may register at www.payspanhealth.com.

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Dear Provider:

Peach State Health Plan (Peach State) has partnered with PaySpan Health to offer you expanded claim payment services. By signing up with PaySpan Health, a web-based application, you will receive convenient electronic claim payments (EFTs), and online remittance advices (ERAs/EOPs). These services assist practices in receiving claims payments quicker. Peach State is offering this service immediately to our providers upon your enrollment with PaySpan Health. Don’t delay, enroll today; call PaySpan Health at 1-877- 331-7154 or register at www.payspanhealth.com.

• Elimination of paper checks – all deposits transmitted via EFT to the designated bank account
• Convenient Payments & Retrieval of remittance information
• Electronic remittance advices presented online
• HIPAA 835 electronic remittance files for download directly to a HIPAA – Compliant Practice Management or Patient Accounting System
• Reduce accounting expenses – Electronic remittance advices can be imported directly into practice management or patient accounting systems, eliminating the need for manual re-keying
• Improve cash flow – Electronic payments can mean faster payments, leading to improvements in cash flow
• Maintain control over bank accounts – You keep TOTAL control over the destination of claim payment funds. Multiple practices and accounts are supported
• Match payments to advices quickly – You can associate electronic payments with electronic remittance advices quickly and easily
• Manage multiple Payers – Reuse enrollment information to connect with multiple Payers Assign different Payers to different bank accounts, as desired

Sincerely,

Peach State Health Plan

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Important Reminder Notice – State Lab Requirements

Attention: Peach State Health Plan Providers

The Georgia Medicaid Program requires that certain lab test be performed at an approved state laboratory. Listed below are lab tests that must be processed at a state approved lab facility:

HIV/AIDS Testing

•  All blood specimens for HIV/AIDS testing must be sent to the Virology laboratory, at the Atlanta Public Health Laboratory location.
• Under no condition will Medicaid reimburse for AIDS testing.
•  Diagnoses include but are not limited to 042-044.9 and 795.8. The procedure codes are: 86689, 86701, 87390, 87536, and 87391.

Please include the member’s Medicaid Number above their name on the specimen requisition form. The member must be eligible for Peach State services on the date services are rendered.

State laboratory locations and telephone numbers are listed below.

For questions regarding the State Lab Requirement for the specified tests, please contact the  Provider Specialist for your region or the Provider Solutions team at (866) 874-0633, Monday-Friday, 7am-7pm.

Sincerely,

Peach State Health Plan

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At Peach State Health Plan, we try to ensure that our providers are well informed about our processes, so that we can better work together to help our members grow healthy and stay healthy. One area that has been identified as an opportunity for improvement is our prior authorization process for drugs.

We have noticed a large number of prior authorization requests that are initially denied when there is not enough clinical information sent with the request. Many of these denials are overturned on appeal, because the appropriate clinical information is sent with the appeal. We know that our physician offices spend much of their time with prior authorization requests, and we want to provide some helpful information to make this process more efficient.

Each time that your office has to file an appeal due to lack of clinical information on the initial request, more of your valuable time is wasted. To partner with you in decreasing the administrative burden, we have some tips for a more efficient prior authorization process.

Many of the Centene/ Peach State Prior Authorization Guidelines require a trial and failure of or contraindication to at least two agents on the preferred drug list before authorization will be granted for a non-preferred drug.

1. If you are sending a request to US Script to ask for a non-preferred drug, please fill out the prior authorization form, but also include chart notes that specify which preferred drugs have been tried, the length of time that they were tried, and what the therapy failure was.
2. Providing as much clinical information as possible for all requests will ensure that the person reviewing the request will have enough information to make an accurate decision based on the Centene/ Peach State criteria.

Prior authorization requests sent to Caremark or directly to Peach State for dispensing out of office stock for Neupogen and Neulasta require specific information for processing.

• If your patient is undergoing chemotherapy and you want to use this drug to prevent neutropenia, please send us the names of the chemotherapy drugs being used for the patient so that we can determine medical necessity.
• If you are using these drugs for a patient who already has neutropenia, please send the most recent CBC’s to include the absolute neutrophil count (ANC).

Prior authorization requests for immunosuppressant drugs will be approved for transplant patients.

• If you are requesting an immunosuppressant for any indication other than a transplant, please send all pertinent clinical information to show how the diagnosis was made and all other therapies that have been tried by the patient.

All prior authorization requests for commonly used drugs (drugs that would not be considered specialty drugs) should be entered on the US Script prior authorization request form and faxed directly to US Script at 866-399-0929.

All prior authorization requests for specialty drugs that will be dispensed out of the physician’s office stock or facility stock should be entered on a Caremark specialty request form, but should NOT be faxed to Caremark. These requests should be faxed directly to the Peach State Health Plan Pharmacy Department at 866-374-1579. Please remember to specify the name of the facility providing the drug (physician office or outpatient facility) on the top of the form and include the phrase “Office Stock” to ensure that we know you will not need Caremark to ship the drug to your office.

All prior authorization requests for specialty drugs that will need to be shipped to the physician’s office or to the patient’s home should be entered on a Caremark specialty request form and faxed directly to Caremark. Faxing these requests directly to Caremark will speed the process and allow better shipping efficiency.

• If you receive notification of approval of your prior authorization request, but are not contacted by Caremark to set up delivery, please call CarePlus Pharmacy at 866-367-5201 to check the status of your shipment.

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