How do I file an appeal with Ambetter?

If you wish to submit an appeal, you will need to follow Ambetter procedures. In order to file an appeal with Ambetter, a provider must complete a Provider Request for Reconsideration and Claim Dispute Form which can be obtained from the Ambetter website.

There are two items on the form which need to be explained:

    1. Provider Tax ID # - This would be the Activ Tax ID #. (The only other time you may use it.)
    2. Control/Claim Number - This would be the Peach State Health Plan (Ambetter) claim number. Within the next week, ActivHealthCare will begin placing the Ambetter claim number on your Remittance Advice. it will be labeled PSHP Clm# and will display on the right-hand side. Until then, you will need to contact ActivHealthCare for that number.

If you have any questions on the process, please do not hesitate to contact ActivHealthCare at (770) 455-0040.