State · GA
Medical billing services in Georgia
Short answer
Medical billing services in Georgia have to work two Medicaid systems at once: fee-for-service claims through the GAMMIS portal and Georgia Families claims through three care management organizations, with CMO filing deadlines as short as six months from the date of service.
Add a single statewide NEMT broker, a state EVV system with optional third-party vendors, and a surprise billing law that sends out-of-network payment disputes to arbitration at the Insurance Commissioner's office. Remitwright assigns a dedicated biller who keeps those rules straight for your practice, serving Georgia practices remotely. Rules for other states are on the medical billing services by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Billing in Georgia: what's different
The rules below change how a claim is filed and paid in Georgia. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.
| Fact | In Georgia | Source |
|---|---|---|
| Medicaid program | Georgia Medicaid (with PeachCare for Kids as the CHIP program)Georgia Department of Community Health (DCH), Medical Assistance Plans Division | 5 |
| Fee-for-service portal | GAMMIS (Georgia Medicaid Management Information System) web portal | 5 |
| Managed care plans | 3 plansAmerigroup Community Care, CareSource, Peach State Health Plan | 4 |
| Medicaid timely filing (Georgia Families CMOs) | Six months from the date of service | 16 |
| Prompt-pay law | O.C.G.A. 33-24-59.5 and 33-24-59.14 | 11 |
| NEMT | One statewide broker | 7 |
| EVV | Netsmart Mobile Caregiver+ is the state's official EVV system | 10 |
Georgia Medicaid (with PeachCare for Kids as the CHIP program)
Georgia Medicaid (with PeachCare for Kids as the CHIP program) is run by the Georgia Department of Community Health (DCH), Medical Assistance Plans Division. Fee-for-service claims and provider enrollment go through the GAMMIS (Georgia Medicaid Management Information System) web portal5, at www.mmis.georgia.gov. Georgia Families, the managed care program DCH introduced in 2006, contracts with private care management organizations (CMOs). Medicaid and PeachCare for Kids both keep a fee-for-service component, and in July 2025 the state counted 1,587,559 Medicaid members in a CMO and 598,061 in fee-for-service2. Children and youth in foster care, those receiving adoption assistance and some youth in the juvenile justice system are enrolled in Georgia Families 360, which Amerigroup has served since 2014.
Medicaid timely filing (Georgia Families CMOs): Six months from the date of service for Georgia Families CMO claims under House Bill 1234, as Peach State Health Plan's resource guide sets out. A denied claim can be corrected within six months of the month of service or three months of the month of denial, whichever is later, and COB claims are due within 180 days of the primary payer's EOP but never more than 12 months from the month of service16. DCH sets the fee-for-service deadline in the Part I Policies and Procedures Manual on GAMMIS, the same manual the Georgia Families contract points CMOs to, so the fee-for-service number comes from the current edition of that manual.
Managed care plans4
- Amerigroup Community CareAlso the single plan for Georgia Families 360 members
- CareSourceNonprofit plan that also serves Planning for Healthy Babies enrollees
- Peach State Health PlanCentene subsidiary
Each plan is credentialed separately, has its own portal and its own appeal route. A practice that joins Georgia Medicaid through one plan is not in network with the others until each contract is in place.
Commercial payers and the prompt-pay law
Commercial payers active in Georgia15: Anthem Blue Cross and Blue Shield, UnitedHealthcare of Georgia, Cigna Healthcare, Kaiser Permanente, Ambetter from Peach State Health Plan, CareSource, Oscar Health, Alliant Health Plans. A Georgia practice works to a separate provider manual for each, with its own filing window, corrected-claim process and appeal levels. Verified payer deadlines, each with its source, are in the timely filing limits table.
Prompt pay in Georgia is governed by O.C.G.A. 33-24-59.5 and 33-24-59.1411. OCI treats both sections as Georgia's prompt pay law for insurers offering and administrators servicing health benefit plans, and requires those insurers to file paid and denied claims data every quarter so the office can check compliance. In A/R follow-up, a clean claim that sits unpaid is escalated with the statute cited.
NEMT and home care in Georgia
Non-emergency medical transportation. One statewide broker. DCH contracts with Verida (formerly Southeastrans) to coordinate and provide NEMT in all five regions (North, Atlanta, Central, East and Southwest) from April 1, 2026, the date Modivcare stopped serving the Central, Southwest and East regions. The broker is paid a monthly capitated rate per eligible member and recruits and contracts with the transportation providers7. Every trip must be scheduled and authorized by the broker, normally three workdays ahead, and transportation providers who want Medicaid work contract with Verida rather than with DCH. The NEMT billing in Georgia page covers trip documentation, broker claims and reconciliation.
Electronic visit verification. Netsmart Mobile Caregiver+ is the state's official EVV system. EVV is implemented for personal care services, including Elderly and Disabled Waiver (CCSP and SOURCE) personal support, ICWP, NOW and COMP services, and home health care services were added after a soft go-live on August 31, 2026: all applicable home health claims with dates of service on or after September 14, 2026 must be submitted through EVV10. The model is hybrid. DCH's EVV third-party information page offers the state system at no cost and lets a provider keep or choose a third-party EVV vendor that is integrated with it, paying any cost of that alternative itself and filing a third-party attestation. See home care billing in Georgia for waiver programs, EVV exceptions and authorizations.
Rules that change how Georgia claims are billed
Surprise billing is settled between insurer and provider, not the patient12
Under the Surprise Billing Consumer Protection Act (HB 888, effective January 1, 2021), an insurer must pay for emergency services whether or not the provider or facility is in network, and a nonparticipating provider may collect no more than the patient's deductible, coinsurance, copayment or other cost sharing for emergency services and for nonemergency services that produce a surprise bill. The insurer pays the provider directly, and the payment amount can go to arbitration.
Arbitration requests go to the Insurance Commissioner13
OCI's arbitration program under O.C.G.A. 33-20E began July 1, 2021. A request must include the claim number, dates of service, the billed and paid amounts, the place and type of service and whether the provider is non-participating. Both parties get 30 calendar days to negotiate before referral, and OCI will not take general billing disputes, only claims where the insurer is not meeting 33-20E-4 or 33-20E-5.
Telehealth pays at least the in-person rate14
HB 307 (2021) amended the Georgia Telehealth Act so insurers reimburse telemedicine on the same basis and at least at the rate they pay for the same service in person, cannot impose a separate telemedicine deductible, and cannot require an in-person visit first. Audio-only is allowed only when no real-time video option is available, and insurers need not pay for audio-only visits other than mental or behavioral health services.
CMOs run on a 15-business-day claims clock with 20 percent interest17
The Georgia Families contract requires a CMO to suspend a claim that is not clean and request the missing information within 15 business days of receipt, finish processing within 15 business days after the information arrives, run at least one payment cycle a week, and pay 20 percent per annum interest, counted from 15 calendar days after submission, on any claim it denied or underpaid and later owed.
One credentialing file for all three CMOs18
Since August 1, 2015, DCH has used an NCQA-certified centralized Credentialing Verification Organization for providers enrolling or recredentialing with Georgia Families and Georgia Families 360 CMOs, so one application and one set of credentialing documents go through a single web portal instead of separate submissions to each CMO.
Pathways to Coverage members must keep up qualifying activities19
Georgia Pathways covers residents who meet program requirements and are not otherwise eligible for traditional Medicaid. Members report qualifying activities to keep coverage, and the eligibility requirements change on January 1, 2027, so an eligibility check on the date of service matters for these members.
Services for Georgia practices
Remitwright serves Georgia practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.
- Medical billingClaims worked by one named biller
- CredentialingEnrollment, CAQH and PECOS kept current
- Eligibility verificationCoverage and benefits checked before visits
- Prior authorizationAuths requested, tracked, attached to claims
- Denial managementEvery denial read, worked and appealed
- A/R follow-upUnpaid claims chased before filing limits
FAQ
Questions from Georgia practices
Which Georgia Medicaid plan do I bill for a patient?
Do I need a different provider number for each CMO?
What is the timely filing limit for Georgia Medicaid claims?
How quickly do Georgia insurers have to pay a clean claim?
How does NEMT billing work in Georgia now that there is one broker?
Do home care agencies have to use the state EVV system?
Can we balance bill an out-of-network patient we treated in a Georgia hospital?
Which commercial payers should a Georgia practice expect to bill?
Who runs Medicaid in Georgia, and where do fee-for-service claims go?
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