Thank you for your interest in participating in the network for Peach State Health Plan. To learn more, please click on the forms below:
NEW PROVIDERS (Medicaid and Medicare)
Please complete the Network Participation Request form to inquire about participation. You must have a valid Medicaid ID number to submit a request. You can apply for a Medicaid ID number at: https://www.mmis.georgia.gov/.
EXISTING CONTRACTED PROVIDERS (Medicaid and Medicare)
Please use this link to add a provider, location, or product to your existing contract. Fax the completed forms to: (866) 896-8261.
AMBETTER NETWORK PARTICIPATION REQUEST
Please complete the Ambetter Network Participation Request form to get more information about participating in our Health Insurance Marketplace product.
Please note the following specialties have different participation requirements. Select the appropriate link below for more detailed information.
You may view our credentialing forms here.