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.

No Authorization Required

 Ambulatory Surgery Centers “Effective 09/01/09”

• Procedures and diagnostics performed at participating Ambulatory Surgery Centers by participating providers
  • Non-participating providers must obtain prior authorization
  • All procedures of a cosmetic nature, require prior authorization

Emergency/Urgent Care

• Emergent transportation services including Air, Water and Ground
• Urgent or emergent care services rendered in emergency rooms and urgent care centers.

Primary Care

• Primary care provider office visits and minor procedures. Including EPSDT (Early Periodic Screening Diagnostics Treatment health Check)
• *Certain diagnostic tests and procedures that are considered by the health plan to be routinely part of an office visit.

Maternity/OB

• Annual wellness exam, including pap-smear
• Labor checks
• OB Ultrasounds (up to two for routine ultrasounds for participating and non-participating providers)

Specialist

• Dermatology
• Ophthalmology

Laboratory

• Routine Laboratory tests consistent with CLIA guidelines (participating and non-participating)

Radiology

• *Plain X-rays in a free-standing imaging center, provider office or clinic or in rural hospital. (participating and non-participating)

Other

• Family Planning Services (excludes fertility)
  • “Effective 08/17/09” – Prior notification is required for both Mirena and ParaGard IUDs. Peach State must be notified prior to insertion to guarantee payment. Please use the notification form found on the website
• Hearing evaluations

*CPT code must be included with request and claim submission

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