Medical Billing in Georgia

What is specific to Georgia

Georgia Medicaid runs through Care Management Organizations, each with its own credentialing process.

Georgia’s Medicaid programme is Georgia Medicaid. Practices with a meaningful Georgia Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.

What a medical billing seat does in Georgia

Aged accounts receivable called until they close, and denials read, appealed and tracked.

In Georgia the queue that costs the most is Georgia Medicaid, because its filing window and appeal route are not the commercial ones.

• Worklist worked from the difficult end, not the easy end
• Every call logged with the payer reference and the outcome
• Denials categorised so the same reason stops recurring
• Appeals written and submitted, not just re-bills
• Weekly written summary of what moved and what did not
• Worked during Georgia business hours, not queued overnight

Most of the Georgia work we see comes out of Atlanta, Augusta and Savannah, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.

Georgia borders 5 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from Georgia Medicaid, and it is the queue that most often goes unworked because it belongs to nobody.

What Georgia law gives you

15 working days for electronic claims; 30 calendar days for paper claims. Interest of 12 percent per annum applies to late payment.

Source.

Georgia Medicaid, in practice

Managed care through Georgia Families, with only three contracted Care Management Organizations (CMOs) — Amerigroup Community Care, CareSource, and Peach State Health Plan — the smallest MCO panel of the five states reviewed. Source

Georgia carves its entire foster care, adoption assistance, and select juvenile justice population (~27,000 members) into Georgia Families 360°, a single statewide CMO run by Amerigroup Community Care of Georgia. If a practice sees foster children in Georgia, there is exactly one payer to contract with for that population regardless of county. Source

On the commercial side the dominant Blue plan here trades as Anthem Blue Cross and Blue Shield (in Georgia the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.), which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source

We have not been able to source Georgia’s own Medicaid filing limit from the regulation itself, so this page does not quote one — the federal floor is twelve months from the date of service and a state may set a shorter window. Ask your Georgia Medicaid representative for the figure in writing before you rely on it. The states we could source are listed here.

Working Georgia hours

Georgia runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.

That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Georgia hours and nobody else’s.

What it costs in Georgia

$1,700

Per seat, per month, in US dollars — $20,400 a year for one full-time person, forty hours a week, on Georgia hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Georgia run $1,500 to $2,500; the full list is published.

That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.

Getting started in Georgia

About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.

Questions