Centene / Peach State Health Plan
Welcome to the Peach State Health Plan page. Here you can access helpful information related to the program.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager, Tony Salvati.
Update on COVID-19
RBM Documents
- Peach State Health Plan Frequently Asked Questions
- Peach State Health Plan Imaging Facilities QRG
- Peach State Health Plan Ordering Physicans QRG
- Peach State Health Plan Provider Training
- Peach State Health Plan Utilization Review Matrix-2021
- Pediatric Tip Sheet
- Prior Authorization Checklist
- Test Request Tip Sheet
Cardiac Documents
- Peach State Health Plan - Cardiac Announcement Letter
- Peach State Health Plan - Cardiac Program
- Peach State Health Plan - Cardiac Checklist
- Peach State Health Plan - Cardiac FAQs
- Peach State Health Plan - Cardiac MPI vs SE Tip Sheet
- Peach State Health Plan - Cardiac Tip Sheet
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
NIA Facility Selection Program Updates
- NIA Facility Selection Program Announcement Letter
- NIA Facility Selection Program Announcement Letter for CHOA
Effective November 15, 2017, and for all dates of service thereafter, if you do not select a convenient, cost-effective, in-network imaging facility at intake, NIA will assign one without outreach to the member. In addition, the imaging provider selected will become the provider of record for claims payment of that claim. Any claim billed with an imaging provider that differs from the imaging provider selected/assigned during the authorization process will be denied.
Click the link below to see information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
Clinical Guidelines
- Clinical Guidelines
-
Refer to the Utilization Review Matrix document to view specific codes managed by NIA
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.