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SUBMIT TO Utilization Management Department 1100 Circle 75 Parkway, Suite 1100 Atlanta, GA 30339 Phone: 1.800.704.1483 FAX: 1.844.870.5064OUTPATIENT TREATMENT REQUEST FORMPlease print clearly incomplete.

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Prescription and certain over-the-counter medicines are covered. Your doctor may need to get preapproval for some drugs to be filled. Your request should include why the drug is needed and how much is needed. Requests for brand-name drugs when generics are available also need preapproval.

Failure to file a claim within six months after a service is rendered and/or failure to obtain a required prior approval or precertification will result in a denial of that claim. Obtaining prior approval or precertification does not guarantee payment of a claim. BILLING RESOURCE MANUAL georgia.gov https://dch.georgia.gov › document › download georgia.gov https://dch.georgia.gov › document › download

Peach State Health Plan offers the same benefits covered by Medicaid and PeachCare for Kids®. We also offer enhanced benefits that extend your coverage. Frequently Asked Questions | Georgia Medicaid - Peach State Health Plan pshpgeorgia.com https://.pshpgeorgia.com › resources › faqs pshpgeorgia.com https://.pshpgeorgia.com › resources › faqs

If you need help finding a pharmacy near you, call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056).

What is the timeline for response to a Member Appeal? A member has 180 calendar days from Ambetter's notice of action to file the appeal. Ambetter Provider Claims & Payments FAQ coordinatedcarehealth.com https://ambetter.coordinatedcarehealth.com › dam › PDFs coordinatedcarehealth.com https://ambetter.coordinatedcarehealth.com › dam › PDFs

Timely Filing Requirements: All claims must be received by the plan within six (6) months from the date the service was provided in order to be considered for payment. Claims received after this time frame will be denied for failure to file timely. house bill 1234 resource guide - Peach State Health Plan Peach State Health Plan https://.pshpgeorgia.com › providers › PDFs Peach State Health Plan https://.pshpgeorgia.com › providers › PDFs PDF

Use the Pre-Auth Needed tool on our website to determine if prior authorization is required. Timely Filing guidelines: Six months from date of service.

Pharmacy Benefit Manager (PBM) Peach State Health Plan works with CVS/Caremark to pay for pharmacy claims. CVS/Caremark is our Pharmacy Benefit Manager (PBM).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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