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

General BillingInformation and GuidelinesGENERAL BILLING INFORMATION AND GUIDELINESPhysicians, other licensed health professionals, facilities, and ancillary provider’s contract directlywith Peach State for payment of covered services.It is important that providers ensure Peach State has accurate billing information on file. Pleaseconfirm with your Provider Relations Department that the following information is current in ourfiles:• Provider Name (as noted on his/her current W-9 form)• Valid, unique GA Medicaid ID Number or pending confirmation GAMedicaid ID number for each practicing location• Physical location address (as noted on current W-9 form)• Billing name and address (if different)• Tax Identification Number• Provider NPIProviders must bill with both their provider Taxonomy Code and NPI in box 24J. In addition, youmust include your ID qualifier in box 24I for the Taxonomy Code. Peach State will return claimswhen billing information does not match the information that is currently in our files. Claimsmissing the requirements in bold will be returned, and a notice sent to the provider, creatingpayment delays. Such claims are not considered “clean” and therefore cannot be entered into thesystem.We recommend that providers notify Peach State in advance of changes pertaining to billinginformation. Please submit this information on a W-9 form. Changes to a Provider’s TaxIdentification Number and/or address are NOT acceptable when conveyed via a claim form.Claims eligible for payment must meet the following requirements:• The member is effective on the date of service• The service provided is a covered benefit under the member’s contract on thedate of service• Referral and prior authorization processes were followedPayment for service is contingent upon compliance with referral and prior authorization policiesand procedures, as well as the billing guidelines outlined in this manual.Provider Services1-866-874-063302/22/201166