Manuals, Forms and Resources
Medicaid Resources
Manuals
- Quick Reference Guide HEDIS 2022 (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 Documents
- Quarter 2 2024 SB80 Report (PDF)
- Quarter 1 2024 SB80 Report (PDF)
- Quarter 4 2023 SB80 Report (PDF)
- Quarter 3 2023 SB80 Report (PDF)
- Quarter 2 2023 SB80 Report (PDF)
- Quarter 1 2023 SB80 Report (PDF)
- Quarter 4 2022 SB80 Report (PDF)
- Quarter 3 2022 SB80 Report (PDF)
- Quarter 2 2022 SB80 Report (PDF)
- Quarter 1 2022 SB80 Report (PDF)
- Case Management Fax Form (PDF)
- Provider Notification Form – Diabetes (Diabetes/Chronic Kidney Disease Referral Form) (PDF)
- Therapy Services Attestation (PDF)
- Member Data Change Form (PDF)
- Notification of Pregnancy Instructions (PDF)
- Provider Notification of Pregnancy Form (PDF)
- Social Determinants of Health Provider Referral 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
Continuity of Care Program
Important Notices
Other
- Planning for Healthy Babies Quick Reference Guide (PDF)
- The Supplemental Data Journey (PDF)
- Supplemental Data System Submission Process (PDF)
Provider Toolkit
- PaySpan Guide (PDF)
- Prior Authorization Guide (PDF)
- Simplify Office Administrative Tasks Guide (PDF)
- Secure Portal Guide (PDF)
- P4HB Guide (PDF)
Billing and 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)
- Emergency Ambulance Services Billing Reminder (PDF)
- Place of Service Codes (PDF)
- In Office Lab Testing List (PDF)
Reimbursement Policies
Claims
- CLIA Network Notice (PDF)
- Corrected Claim Submission Process Change (PDF)
- Claims Payment Notification (PDF)
- Claims Submission Time Frames (PDF)
- ED Hospital Claim Review Process – Revised 100609 (PDF)
- Physician Claims – CMS 1500 (PDF)
- OPR Claim Submission Guide – 2016 (PDF)
EDI
- 835 Companion Guide (PDF)
- 835 Claim Adjustment Reason Codes Crosswalk to EX Codes (PDF)
- EDI Rejection Codes (PDF)
Ambetter Manuals & Forms
For Ambetter information, please visit our Ambetter website.
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