Utilization Management

Peach State’s Utilization Management Department hours of operation are Monday through Friday (excluding holidays) from 8 a.m. to 5:30 p.m. Urgent Requests and Admission Notifications should call (800) 704-1483 and follow prompts.

  • To notify the plan of inpatient hospital admissions and observations by the next business day of admission. A telephone authorization must be followed by a fax submission of clinical information by next business day.
  • You may also call to request outpatient authorizations for urgent and time sensitive services when warranted by the patient’s condition. Please include CPT and ICD-9 codes and place of service codes with your authorization request.

For authorization requirements for the following services, please contact the vendors listed below.

Notifications

Forms/Resources

Affirmative Statement

Durable Medical Equipment (DME) and Orthotics/Prosthetics Prior Authorization Required List

Inpatient Prior Authorization Fax Form (PDF)-Effective July 15,2013

Notification of Newborn Delivery (PDF)

Outpatient Prior Authorization Fax Form (PDF)-Effective July 15,2013

Prior Authorization Guide-Revised May 2014