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Product. Peach State Health Plan - Medicaid HMO June 1, 2006 Peach State has delegated credentialing to Kids First. Therefore, it will not be necessary to complete a Peach State application. 3 Tiered Option to be selected by practice: 110% of 2005 Medicaid Fee Schedule
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Product • Peach State Health Plan - Medicaid HMO • June 1, 2006 • Peach State has delegated credentialing to Kids First. Therefore, it will not be necessary to complete a Peach State application. • 3 Tiered Option to be selected by practice: • 110% of 2005 Medicaid Fee Schedule • 105% of 2005 Medicaid Fee Schedule with a $1 mgmt fee • 100% of 2005 Medicaid Fee Schedule with a $2 mgmt fee • Reimbursement selected by practice will apply to all providers listed under Kids First Peach State contract; different reimbursement levels may not be combined within a practice. • Physician listings are available via the internet on the website, www.pshpgeorgia.com Contract Effective Date Reimbursement Network
Referrals only necessary for the following specialties • Oral Surgeons • Plastic & Reconstructive Surgeons • Non-participating or Out-of-Network Providers • Prior Authorization Process • Procedures requiring Prior Authorization: • Inpatient Authorization • DME >$500 • Speech Therapy • Physical Therapy • Out of Network Providers • Home Health Services • Orthotics & Prosthetics >$250 • Pain Management • Injectables > $100 • Provider may obtain Prior Authorization by contacting Medical Management toll-free at 1.800.704.1483 • Emergency admissions require notification within 48 hours. Refer to back of member’s (patient’s) card for contact information. Medical Management
All claims should be submitted on a standard HCFA 1500 form. Claim forms should be mailed to: • Peach State Health Plan • P.O. Box 3030 • Farmington, MO 63640-3805 • Attn: Claims Department • Electronic claims are accepted to the following payor id: WebMD / Emdeon 68049 • Co-payment information and benefits should be verified by reviewing www.pshpgeorgia.com or calling Provider Services at 866.874.0633 • All claims should be submitted using commercial (CPT/ICD-9) billing codes and modifiers. • All claims should be submitted within 120 days of date of service via mail or electronic submission method to the appropriate payor, as indicated on the member’s ID card. • All Membership cards must display the Peach State / Centene logo. • Peach State Health Plan • Peach State Main Line 800-704-1463 • Peach State Provider Relations 678-556-2352 • Eligibility & Benefits 866-874-0633 • Pre-Certification 800-704-1843 • Claims Status 866-874-0633 • Kids First Pediatric Alliance • Main number 770-333-0033 Claims Submission Phone Numbers
