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Recursos para proveedores | Ambetter de Peach State Health Plan
Recursos para proveedores
Ambetter brinda las herramientas y apoyo que usted necesita para dar atención de la mejor calidad.
Reference Materials
- 2026 Provider and Billing Manual (PDF)
- 2025 Provider and Billing Manual (PDF)
- Quick Reference Guide (PDF)
- Pharmacy Guide (PDF)
- Claims, Disputes & Recovery/CCU Guide (PDF)
- ICD-10 Information
- Provider Toolkit
- HEDIS MY2022 Quick Reference Guide (PDF)
- Cultural Competency Provider Training
- New Provider Orientation Training
- Information Hour Webinar (PDF)
- 2023 Provider Training (PDF)
- 2024 Provider Training (PDF)
- January 2024 Provider Information Hour Webinar (PDF)
- 2025 Ambetter Quick Reference Guide (PDF)
- The Supplemental Data Journey (PDF)
- Supplemental Data System Submission Process (PDF)
- Information Hour Webinar February 2025 (PDF)
- Interpreter Request Form (PDF)
- Appointment Standards for Scheduling (PDF)
Medical Management
- Quarter 1 2022 SB80 Report (PDF)
- Quarter 2 2022 SB80 Report (PDF)
- Quarter 3 2022 SB80 Report (PDF)
- Quarter 4 2022 SB80 Report (PDF)
- Quarter 1 2023 SB80 Report (PDF)
- Quarter 2 2023 SB80 Report (PDF)
- Quarter 3 2023 SB80 Report (PDF)
- Quarter 4 2023 SB80 Report (PDF)
- Quarter 1 2024 SB80 Report (PDF)
- Quarter 2 2024 SB80 Report (PDF)
- Quarter 3 2024 SB80 Report (PDF)
- Quarter 4 2024 SB80 Report (PDF)
- Quarter 1 2025 SB80 Report (PDF)
- Quarter 2 2025 SB80 Report (PDF)
- Quarter 3 2025 SB80 Report (PDF)
- Pre-Auth Needed?
- Prior Authorization Guide
- Inpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Fax Form (PDF)
- Outpatient Prior Authorization Supplemental Fax Form (PDF)
- Grievance and Appeals
- Provider Notification of Pregnancy Form (PDF)
- Non-Formulary And Step Therapy Exception Request Form (PDF)
Site of Care Optimization Program
Our Site of Care program focuses on patients receiving infusion therapies or specialty drugs in high-cost setting, such as hospitals. The goal is to transition eligible patients to clinically appropriate lower-cost alternatives — like home infusion or freestanding infusion centers — when suitable. Learn more about the Site of Care program.
Resources
- Infusion Therapy Site of Care Optimization Clinical Policy (GA.PMN.34) (PDF)
- Prescriber Quick Reference Guide: Site of Care Redirection (PDF)
- Site of Care Optimization Program Frequently Asked Questions (FAQs) (PDF)
Infusion Providers
| Provider Name | Services Offered | Phone Number | Fax Number | Nursing Services |
|---|---|---|---|---|
| AcariaHealth | Home | 855-535-1815 | 855-217-0926 | Yes |
| Accredo | Home or AIS | 888-773-7376 | 407-852-4926 | Yes |
| KabaFusion | Home or AIS | 888-211-8316 | 405-758-5175 | Yes |
| OptionCare | Home or AIS | 844-672-4842 | 888-979-8904 | Yes |
| Soleo | Home or AIS | 844-999-5050 | 407-605-5853 | Yes |
| 1st American | Home or AIS | 229-242-3060 | 229-242-9914 | Yes |
Behavioral Health
- Discharge Consultation Form (PDF)
- Discharge Planner Checklist (PDF)
- OTR Completion Tip Sheet (PDF)
- Behavioral Health HEDIS Provider Toolkit (PDF)
- Suicide Prevention (PDF)
Behavioral Health and Quality
- Coordination Of Care (PDF)
- Discharge PlannerChecklist (PDF)
- Microlearning Strategies (PDF)
- Improving Patient Engagement In Behavioral Healthcare (PDF)
- Cahps® Experience Of Care And Health Outcomes (ECHO) Survey (PDF)
- Primary Care Provider (PCP)/Behavioral Health (BH) Provider Communication Form (PDF)
- Reducing The Stigma Surrounding Mental Illness (PDF)
- Quality Rating System (QRS) Behavioral Health Measure Toolkit (PDF)
Claims and Claim Payment
- Claims, Disputes & Recovery/CCU Guide (PDF)
- Claim Dispute Form (PDF)
- Ambetter Taxonomy Guide (PDF)
- No Surprises Act Open Negotiation Form (PDF)
Quality
- Quality Improvement Program Results
- Practice Guidelines (PDF)
- Quality Improvement (QI)
- Psychiatric Collaborative Care Model (CoCM) (PDF)
- Providing Quality Care