Peach State Provider Office Manual - Peach State Health Plan ...

• In order to reimburse providers for these services, in most case you will need to initiatean appeal and supply the plan with proof that verification was obtained via the GHP webportal within the 72 hour time frame.Appeals should be submitted to:Peach State Health PlanP.O. Box 3000Farmington, MO 63640-3812Please Note: This policy only applies if the steps identified above are followed. As a reminder, Medicaid is the payer of last resort;therefore this policy does not supersede the CMS guidelines related to Coordination of Benefits.Peach State has the capability to receive an ANSI X12N 270 health plan eligibility inquiry andgenerate an ANSI X12N 271 health plan eligibility response transactions through Peach State.Providers also may verify member enrollment through Peach State’s website at www.pshp.com.For more information on conducting these transactions electronically contact:Peach Statec/o Centene EDI Department1-800-225-2573, extension 25525or by e-mail at:EDI@centene.comUntil the actual date of enrollment with Peach State, Peach State is not financially responsible forservices the prospective member receives. In addition, Peach State is not financially responsiblefor services members receive after their coverage has been terminated. However, Peach State isresponsible for those individuals who are Peach State members at the time of a hospital inpatientadmission and change health plans during that confinementNEWBORN ENROLLMENTProviders are encouraged to refer the mother to Peach State to select a PCP for their newborn. Anewborn enrollment packet will be mailed to all Peach State expectant mothers. If the motherdoes not select a PCP after delivery, the mother’s PCP will automatically be assigned to thenewborn, unless the PCP is not accepting new members or the provider has age restrictions.To make a PCP selection for the newborn, members should be referred to:Member Services Department1-800-704-1484TDD/TTY 1-800-659-7487All providers are also encouraged to direct the mother to her county caseworker to ensure thenewborn is officially deemed eligible for the Peach State program.NEWBORN PAYMENT RESPONSIBILITYPeach State is responsible for payment of services for newborn infants born to Peach Stateenrolled mothers until the newborn is discharged to a home environment. Listed below isadditional information regarding payment responsibility for newborns: unless the mother choosesa different Medicaid plan.• Inpatient care for newborns born on or after their mothers’ effective date will be the48Provider Services1-866-874-063302/22/2011