Become a Provider

Thank you for your interest in participating with Peach State Health Plan (Peach State). We are excited that you have selected Peach State’s provider network as your network of choice.

Please note that all requests for participation will be reviewed by Peach State’s Recruitment Committee. This committee meets monthly to carefully evaluate each request submitted. The Recruitment Committee uses several factors when making a decision. Such factors may include but are not limited to:

  • Number of Peach State members in your area
  • Number of currently contracted Peach State providers in your specialty in your geographic area
  • Driving distance between members contracted Peach State providers
  • Peach State business needs

All applicants will be notified in writing by the Contracting Department as to the decision of the committee within approximately 45 business days of receipt of your request.

To enroll complete the Contract Request Form (PDF) and the W-9 Form and fax it to 866-896-8261.

You may view our credentialing forms here.

Please note the following specialties have different participation requirements. Select the appropriate link below for more detailed information.

Dental

Behavioral Health

Home Health/DME/Infusion/Orthotics & Prosthetics

Vision