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

amount, but we will not exceed the amount we would have paid had we paid as the primarycoverage.• If a third party health insurance carrier requires the member to pay cost-sharing amounts(e.g. co-payments, coinsurance, and deductible), Peach State will pay the cost sharingamount but we will not exceed the amount we would have paid had we paid as the primarycoverage.• Providers will receive written notification along with primary payor information prior to PeachState initiating a recoupment. Recovery efforts will apply only to claims that are less thantwelve months from the date the claims was paid• Information regarding the other liability coverage is available through our call center, and viathe secure web portal.• Claims originally filed timely with a third party carrier must be received within 180 days of thedate of the primary carrier’s EOP, but never more than twelve (12) months from the month ofservice.• To the extent permitted by state and federal law, Peach State will use cost avoidanceprocesses as required by DCH.Provider Services1-866-874-063302/22/201191