Thank you for your interest in participating in the network for Peach State Health Plan.
Effective 12/1/2015, The Georgia Department of Community Health (DCH) will require all Medicaid providers seeking to enroll in the Peach State Health Plan Provider Network or any other CMO network to be credentialed and re-credentialed by the centralized Credentialing Verification Organization (CVO). Therefore, it will also be necessary for you to submit a credentialing application to the CVO prior to your acceptance in to our Provider Network.
For further information regarding the new CVO credentialing process, please visit DCH provider portal: www.mmis.georgia.gov or contact HP Provider Call Center at 1-800-766-4456.
To learn about participating in the network, please click on the forms below:
PROVIDER CONTRACT REQUEST FORM (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/.
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: You are required to complete an Attestation and W-9 Form to add a new provider to an existing contract. Click on this link to access to form.
Providers with the following specialties have different participation requirements. Select the appropriate link below for more detailed information.