• DCH Suspension of Providers Who Have Not Revalidated Their Medicaid Enrollment by 4/1/15

    Section 6401 (a) of the Affordable Care Act (ACA) established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation initiative applies to those providers and suppliers that were enrolled in Georgia Medicaid prior to December 31, 2012. Newly enrolled providers and suppliers who were…

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  • Outpatient Observation Reimbursement Policy

    In accordance with Department of Community Health policy, Peach State Health Plan will modify its outpatient observations policy. Effective May 15, 2015, Peach State Health Plan will provide reimbursement for medically necessary observations up to 24 hours, and will not require a medical necessity review of these services. Claims submitted for more than a 24…

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  • Ordering, Prescribing or Referring Requirement Claim Submission Guide

    In accordance with the Affordable Care Act (ACA), and Georgia Department of Community Health, Peach State Health Plan requires that any physician, or other practitioner, who orders, prescribes, refers or renders services to Georgia Medicaid beneficiaries be enrolled in the Georgia Medicaid program. Additionally, Peach State Health Plan requires that claims submitted by rendering providers…

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