Important Prior Authorization Updates

Date: 08/18/25

(Effective Oct. 15, 2025)

Thank you for being a participating provider with Ambetter from Peach State Health Plan. As part of our ongoing work to improve the prior authorization (PA) process for both providers and members, we want to share some important updates to our PA requirements. This work is aligned with broader industry efforts, driven by commitments to regulatory agencies and America’s Health Insurance Plans (AHIP), to modernize and streamline prior authorization. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

A full list of code changes for Ambetter from Peach State Health Plan, including Marketplace Ambetter Health, can be found on our website at https://www.ambetterhealth.com/en/ga/. These changes may include:

• Removing PA requirements based on criticality of review and clinical need.
• Creating a more uniform set of prior authorization requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

If you have questions about specific prior authorization codes or how these changes affect your practice, please reach out to your local Provider Engagement representative or contact Ambetter from Peach State Health Plan’s provider services team at 1-877-687-1180.