Marlien · Payer guide
Peach State Health Plan (Georgia)
Peach State Health Plan, Inc. (Centene Corporation)
- GA
- Georgia Medicaid (Georgia Families / 360)
- Marketplace (Ambetter)
Where you file
- How you apply
- GAMMIS (Medicaid, via the DCH Centralized CVO) + the Peach State Provider Contract Request Form; Ambetter uses its own Network Participation Request
- The path
- Medicaid: GAMMIS → DCH CVO credentialing → Provider Contract Request Form. Marketplace (Ambetter): CAQH + Availity Essentials + the Ambetter Network Participation Request.
- What access you need
- Peach State Provider Services 1-866-874-0633 · Ambetter from Peach State 1-877-687-1180 · DXC Provider Call Center (CVO) 1-800-766-4456
- Who verifies
- Georgia DCH Centralized CVO — Peach State does not credential Georgia Medicaid internally
- Worth knowing
- Peach State's own provider pages state that DCH requires every Medicaid provider seeking to enrol in the Peach State network — or any other CMO network — to be credentialed by the centralized CVO first, and that the CVO application is submitted through GAMMIS. Availity Essentials is the secure provider portal for both Peach State and Ambetter.
CAQH
- Required
- One CAQH profile serves every payer on the list — the AUTHORIZATION is per payer. Ambetter's 2026 Georgia provider manual asks practitioners to self-register with CAQH ProView at proview.caqh.org if they are not already registered.
- Authorise this payer
- Peach State
Lines of business
Each line is its own application, with its own checklist, its own effective date and its own contract. Filing one does not file the others. What follows is what this payer asks for, line by line.
Georgia Medicaid (Georgia Families / 360)
The DCH CVO decides; Peach State contracts. Peach State's DCH contract is extended only to 30 June 2027 while the procurement is unresolved — see the transition gate on this filing.
What to watch for on this line
- Must be trueTRANSITION GATE — Peach State is an incumbent whose DCH Medicaid contract runs only to 30 June 2027. DCH has not issued a Notice of Award and has published no implementation date. Confirm the current CMO list on DCH's own page before you commit.Our own bar, not a published payer rejection rule. DCH: the CMO procurement is in the protest phase pending the Notice of Award, and the current CMO contracts are extended through 30 June 2027 (SFY2027). The Marketplace line is NOT affected — Ambetter is a marketplace contract, not a Georgia Medicaid contract.
Marketplace (Ambetter from Peach State)
AMBETTER IS PEACH STATE'S MARKETPLACE PRODUCT — underwritten by Ambetter of Peach State Inc. It is an ACA marketplace plan, NOT A MEDICAID PLAN, and it is a separate contract from Peach State Medicaid. Ambetter decides at a Credentialing Committee that meets at least monthly, a primary care provider cannot accept member assignments until fully credentialed, and the timely filing window is 180 days from the date of service for participating providers.
What to watch for
The things that quietly stop a file, whichever line of business you are filing.
- Must be trueBehavioral health provider? Peach State runs a SEPARATE behavioural health application — this medical checklist does not cover itPeach State's behavioural pack is a Behavioral Health Facility and Ancillary Credentialing Application plus a Behavioral Health Provider Specialty Profile, and Ambetter has its own Behavioural Health Join Our Network form. For a solo behavioural provider this is usually lighter than a facility application, but the pack is not the medical pack. Confirm which one applies before you file.
What the payer publishes about time
- Completeness review
- Ambetter: allow 7–10 business days for the network participation request to be evaluated and answered. Medicaid: the CVO completeness review gates the 45-day clock.
- Decision
- Medicaid: DCH CVO decision within 45 calendar days of a complete application. Marketplace: the Ambetter Credentialing Committee decision, normally at its next regularly scheduled meeting after a clean application.
- Committee
- DCH CVO Credentialing Committee (Medicaid) · Ambetter Credentialing Committee (Marketplace)
- Contract
- Peach State issues its provider agreement after the CVO decision; Ambetter confirms acceptance after the committee decision
- What the numbers mean
- On Ambetter the committee usually decides at its NEXT regularly scheduled meeting after a clean application is received — so the calendar you get is the committee's, not yours.
Deadlines that start a clock
Peach State's DCH Medicaid contract ends — 30 June 2027 at the latest
Ambetter appeal — written appeal within 30 calendar days of the credentialing decision30 calendar days
counted from the payer's decision
Recredentialing
- Cycle
- 36 months
- What it hangs on
- NCQA / CVO cycle (Medicaid) · 36 months (Ambetter, per the 2026 Georgia provider manual)
- Worth knowing
- Ambetter's manual states that recredentialing is required every 36 months to maintain active network status.
The effective date
Approval is not the date. These are the markers that make a date real.
- How it is established
- Medicaid: the CVO decision, then Peach State's provider agreement, then the roster load. Marketplace: the Ambetter Credentialing Committee decision, then the roster load.
- What proves it
- Peach State provider agreement plus roster confirmation; for Ambetter, the committee decision and roster confirmation
- Contract date
- This is not the same as the contract effective date. Track both.
- Worth knowing
- Two different plans sit inside one company. A Peach State Medicaid effective date says nothing about Ambetter, and an Ambetter effective date says nothing about Medicaid.
What we checked, and what we did not
Contract Request Form and Become a Provider pages, the behavioural health pack, provider services and representative numbers, the Ambetter 2026 Georgia provider manual and quick reference guide, the GAMMIS and DCH CVO route, DCH's own current list of contracted CMOs, the 30 June 2027 contract extension and the 1 July 2026 revalidation suspension confirmed against Peach State, Ambetter, DCH and GAMMIS primary pages on 2026-11-04.
The payer's own pages
Where to file
- Provider Contract Request Form (Medicaid and Medicare) — Peach StatePeach State › For Providers › Become a Provider › Provider Contract Request FormA valid Georgia Medicaid ID number is required to submit the request. Completion of the form is a request to participate; the network is evaluated.
- Become a Provider — Peach StateStart here — the contract request form, the Join Our Network page, and the specialty-specific requirements for dental, behavioural health and vision.States that DCH requires every Medicaid provider seeking to enrol in the Peach State network, or any other CMO network, to be credentialed by the centralized CVO before acceptance into the network.
- Ambetter Network Participation Request — GeorgiaAmbetter from Peach State › Provider Resources › Join Our NetworkMarketplace line only. Completion of the form is an expression of interest: the request is evaluated against membership needs in the practice area and Ambetter replies within 7–10 business days. There is a separate Behavioural Health Join Our Network form.
- Georgia Medicaid enrollment — GAMMIS (DCH Enrollment Broker)Georgia Medicaid Management Information System — required BEFORE CMO participationMedicaid line only. From 1 July 2026 a provider who has not revalidated is suspended and cannot participate.
- CAQH / DataSpring — authorize Peach StateProView › Authorization tab › confirm Peach State is listedOne CAQH profile serves every payer on the list; the AUTHORIZATION is per payer.
Information and forms
- Georgia DBHDD — Become a Provider (Community Behavioral Health)Georgia Medicaid behavioural health has its OWN state enrolment, separate from GAMMIS and from the health-plan contract: a New Provider Enrollment Forum, a Letter of Intent during an open enrollment period, an application, and a site visit if one is required. The Georgia Collaborative (Carelon) is the ASO that runs it for DBHDD. Credentialing and enrollment questions go to GACollaborative@carelon.com; documents go to GAEnrollment@carelon.com.
- Peach State provider portal and resourcesProvider Services 1-866-874-0633, Monday to Friday 7 a.m. to 7 p.m.
- Behavioral Health — Peach StateBehavioural health runs its own pack: a Behavioral Health Facility and Ancillary Credentialing Application and a Behavioral Health Provider Specialty Profile. Ambetter's behavioural forms live here too.
- Ambetter from Peach State — Georgia provider resourcesAmbetter from Peach State Health Plan is underwritten by Ambetter of Peach State Inc., a Qualified Health Plan issuer in the Georgia Health Insurance Marketplace. Availity Essentials is the secure provider portal.
- Ambetter Georgia — 2026 provider manual (PDF)Credentialing Committee, 36-month recredentialing, the 30-day appeal window, and the rule that primary care providers cannot accept member assignments until fully credentialed.
- Ambetter Georgia — quick reference guide (PDF)The 180-day timely filing window for participating providers, 90 days for non-par providers.
- Georgia DCH — Centralized CVO
- Georgia Medicaid — Care Management Organizations (DCH)
- Georgia Families — Latest News (procurement status)
Who to contact
- Peach State Provider ServicesCredentialing questions, application status, claims1-866-874-0633Monday to Friday, 7 a.m. to 7 p.m.
- Ambetter from Peach State — Credentialing DepartmentMarketplace credentialing status, appeals and network participation1-877-687-1180TTY 711. Also the Ambetter Provider Engagement line.
- DXC Provider Call CenterGeorgia Medicaid CVO questions for Peach State1-800-766-4456Peach State's own provider pages give this number for the DCH CVO credentialing process.
- Availity Client ServicesAvaility Essentials account1-800-282-4548 (1-800-AVAILITY)Ambetter's manual points new administrators at availity.com/multi-payer-portal.