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  • Provider Appeal Request Form Pdf - Peach State Health Plan

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Provider Appeal Request Form Please utilize this form to request a Provider Appeal. Note: Requests must be submitted within 30 calendar days of the claim denial. Appeals may be sent individually or.

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There are two ways to file an appeal: Write and ask to appeal. Mail the appeal request and all medical information to: Peach State Health Plan. Grievance & Appeals Coordinator. 1100 Circle 75 Pkwy. Suite 1100. Atlanta, GA 30339. 1-866-532-8855 Fax. Call Peach State toll free at 1-800-704-1484, TTY/TDD 1-800-255-0056.

Medicaid vs. PeachCare for Kids: The main difference between Medicaid and PeachCare for Kids is the income level. PeachCare for Kids serves working families whose income is more than that set by the Medicaid Program.

Located in Atlanta, Georgia, Peach State Health Plan is a Care Management Organization that provides health care services through its provider network, to Georgia residents on Medicaid and PeachCare for Kids®.

Please utilize this form to request a Provider Appeal. Note: Requests must be submitted within 30 calendar days of the claim denial.

A member may make request for an Appeal by phone or in person by calling Member Services toll free at 1-800-704-1484. If the member is hearing impaired they can call 1-800-659-7487. The member must also send Peach State Health Plan a signed letter confirming their request within 30 calendar days of their oral request.

Who is Peach State Health Plan? Peach State Health Plan (Peach State) is a health plan participating in Georgia Families® (GF). It is a managed care program for Medicaid and PeachCare for Kids® members. We offer our members local healthcare programs and services.

Peach State Health Plan provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services Peach State Health Plan offers. Need help understanding these benefits and services? Call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056).

Georgia Medicaid first adopted managed care in 1993 and transitioned to a statewide Medicaid managed care system called Georgia Families in 2006.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232