Manuals, Forms and Resources
Medicaid Resources
Manuals
- Quick Reference Guide HEDIS 2020 (PDF)
- Peach State Health Plan Provider Manual (PDF)
- DCH Provider Manual
- Federally Qualified Health Center Manual
- Rural Health Clinic Services Manual
Appeals
Claims
Medical Management Forms
- Case Management Fax Form (PDF)
- Provider Pregnancy Incentive Form – revised 2015 (PDF)
- Provider Notification Form – Diabetes (Diabetes/Chronic Kidney Disease Referral Form) (PDF)
- Therapy Services Attestation (PDF)
- Universal 17-P-Authorization Form (PDF)
- Community Health Services Provider Referral Form (PDF)
- Member Data Change Form (PDF)
- Provider Notification of Pregnancy Form
NOTE: All Pregnancy Notifications must be submitted via the GAMMIS portal.
Please submit notifications using the standardized Pregnancy form located on GAMMIS Georgia Medicaid Management Information System (GAMMIS)
Member Services
Other
Billing/Reimbursement
- Billing Reminder: Tobacco Cessation Therapy Services (PDF)
- Billing Reminder: Front End Paper Claim Processing
- Billing Reminder: Immediate Postpartum LAR (PDF)
- Georgia Ordering, Prescribing or Referring (OPR) Provider Notice (PDF)
- CPT Category II Codes Guide (PDF)
- Emergency Ambulance Services Billing Reminder (PDF)
- Place of Service Codes (PDF)
- In Office Lab Testing List (PDF)
Reimbursement Policies
Ambetter Manuals & Forms
For Ambetter information, please visit our Ambetter website
Allwell Provider Resources
For Allwell Provider information, please visit our Allwell Provider Resources page.
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