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.

Click here to view Peach State Health Plan’s Prior Authorization List (PDF)

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

• Hitech imaging such as: CT, MRI , PET and all other imaging services: National Imaging Association (NIA) - http://www.radmd.com
• Home health, durable medical equipement and home infusion: Univita - https://providers.univitahealth.com/

Notifications

• ED Hospital Claim Review Process
• Hospital to Hospital Back Transfer Policy (PDF)
• Notification of Newborn Delivery (PDF)
• Prior Authorization Hospital Letter (PDF)

Forms/Resources

Prior Authorization Form (Revised 6/2011)

Prior Authorization Guide-Revised April 2013

Notification of Newborn Delivery (PDF)

Affirmative Statement