Mmis georgia gov 2025

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The document is a Multi-Ingredient Compound Drug Prior Authorization Form for Georgia Medicaid Fee-for-Service. It outlines the necessary information and steps required to request prior authorization for compound medications, including specific details about the member, prescriber, and requested compounds. It also notes that requests for Proton Pump Inhibitors require an additional form and provides contact information for special cases.

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Click ‘Get Form’ to open the Georgia Medicaid Fee-for-Service Multi-Ingredient Compound Drug Prior Authorization Form in our editor.
Begin by filling in the MEMBER section. Enter the Last Name, First Name, ID number, and Date of Birth accurately to ensure proper identification.
Next, complete the PRESCRIBER section. Input the Prescriber’s Last Name, First Name, NPI#, Phone, Fax, and Address for verification purposes.
In the Member Diagnosis field, provide a clear description of the diagnosis related to the compound request.
Indicate the Compound Requested and explain why a commercially available product is not suitable if applicable. Include any previous failed therapies.
List each Ingredient Name required for the compound in the designated fields. Ensure all ingredients are accounted for.
Fill in Pharmacy details including Name, Phone, NCPDP #, and Facsimile. This information is crucial for processing your request.
Finally, sign and date where indicated by the Pharmacist Signature field before submitting your form.

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What are the different types of Medicaid in Georgia?

Adults Health Insurance Premium Payment Program (HIPP) Georgia Medicaid members who are employed may be eligible for health insurance premium assistance through a Medicaid program called the Health Insurance Premium Payment Program (HIPP). Planning for Healthy Babies® (P4HB)

Does Medicaid cover dental for adults in Georgia?

Both adults and children who are enrolled in Georgia Medicaid or PeachCare for Kids® are eligible for dental services.

What is my Georgia Medicaid provider number?

Contact Georgia Medicaid Peachcare for Kids®877-427-3224Member Services866-211-0950Provider Services800-766-4456Customer Service/Claims Resolution404-657-5468Medical Policy404-651-96062 more rows

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What is GA Medicaid called?

Peach State Health Plan (Peach State) is a physician-driven, Georgia-based Medicaid managed care plan.

How do I check my Medicaid status in GA?

How can we help? Call Us. Primary: (404) 657-5468. Toll Free: (877) 423-4746. Email Us. Online Form.

How do I get a Medicaid provider number in Georgia?

The Provider Enrollment Unit can be reached at the following: Fill out the Contact Us form. Call the local number (770) 325-9600. Call the toll-free number (800) 766-4456.

How do I become a Medicaid provider in GA?

Go to the Georgia Web Portal homepage at www.mmis.georgia.gov and click on the Provider Enrollment/Enrollment Wizard link. Scroll down to the bottom left side of the page and click on Provider Enrollment Application. Then click on the continue application button and enter the ATN and Business or Last Name.

How can I get my Georgia Medicaid number?

To apply for Medicaid, please apply online https://gateway.ga.gov or in person at your local DFCS county office or or request an application by calling 877-423-4746....Contact Georgia Medicaid. Peachcare for Kids®877-427-3224Hospital Services404-651-96065 more rows

Mmis georgia gov 2025

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How do I sign my mmis ga free of charge?

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What is GA Medicaid called?

How do I check my Medicaid status in GA?

How do I get a Medicaid provider number in Georgia?

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