Timely filing · Georgia Families CMOs
Georgia Medicaid timely filing limit
Short answer
The Georgia Medicaid timely filing limit at Peach State Health Plan, one of the Georgia Families care management organizations, is six months from the date the service was provided, and a claim received later is denied for failure to file timely. A claim denied for wrong or missing information can come back within six months of the month of service or three months of the month of denial, whichever is later.
A claim appeal is due within 30 calendar days of the denial. Federal rule 42 CFR 447.45 requires every state Medicaid agency to have claims submitted within 12 months of the date of service. Compare other payers in the timely filing limits table.
Last reviewed by the Remitwright billing team. Editorial policy
The windows
- Initial claim
- Six months from the date of service at Peach State Health Plan, a Georgia Families CMO; a claim the plan receives after that is denied for failure to file timely1
- Counted from
- The date the service was provided, to the date Peach State receives the claim. The manual's claim filing checklist words the same limit as six months from the month of service, so get the claim in before six months have passed since the service date, which meets both readings. Resubmission and adjustment windows count in months, from the month of service, the month of denial or the month of payment on the EOP.
- Appeal
- A claim appeal on Peach State's Provider Appeal Request Form, filed no more than 30 calendar days past the denial date. After the internal appeal, 15 business days from receipt of the plan's decision to request an administrative law hearing, or choose binding arbitration instead.
- Corrected claim
- A claim denied for wrong or missing information within six months of the month of service or three months of the month of denial, whichever is later. An adjustment request for a billing error or a payment you think is wrong within six months of the month of service or three months of the month of payment on the EOP, whichever is later. Mark either one with resubmission code 7 and the original claim number.
- Verified
- , against the payer document in the sources
Your participation agreement can set a different window. Where the contract and the manual disagree, the contract applies.
A visit on Monday, March 2, 2026
Counting 6 months forward from a date of service of Monday, March 2, 2026 gives Wednesday, September 2, 2026. That is the last day to file under the first limit shown above; a claim filed after it is outside the window unless one of the exceptions below applies.
Exceptions the payer allows
Another insurer paid first
A claim filed on time with a third-party carrier must reach Peach State within 180 days of the date of the primary carrier's EOP, and never more than 12 months from the month of service.
Late resubmission of a denied claim
A paper resubmission sent more than six months after the month of service needs a copy of the EOP showing the denial attached, so the plan can see the original claim went in on time.
Newborn claims
The manual allows the filing limit to be extended for newborn claims when Peach State is the secondary payer, and for newborn claims whose eligibility Peach State received retroactively, up to a maximum of 365 days.
Eligibility checked within 72 hours of the service
Peach State honors claims for services performed within 72 hours after an eligibility check on the Georgia MMIS web portal. Print the eligibility screen with its date and time stamp, because in most cases the claim needs an appeal with that print attached.
Hospital outlier reconsideration
A hospital asking for outlier payment on a DRG claim must get the request and every required document to the plan within three months from the month Peach State paid the inlier case rate, or the request is denied as untimely.
What counts as proof of timely filing
- A copy of the EOP showing the original denial, attached to a paper resubmission sent more than six months after the month of service
- The primary carrier's EOP, whose date starts the 180-day coordination of benefits window
- A dated and time-stamped print of the GAMMIS eligibility screen for the 72-hour eligibility rule
- The Provider Adjustment form with its supporting documentation for each adjustment request
- Your electronic submission audit report showing Peach State accepted the claim, which the manual makes the provider's job to check
Notes for billers
- CMS lists three Georgia Families CMOs as of July 1, 2024: Amerigroup Community Care (Elevance Health), CareSource Georgia and Peach State Health Plan (Centene). Amerigroup also runs Georgia Families 360. The windows on this page are Peach State's, so check the manual of the plan the member is enrolled with before you rely on them for Amerigroup or CareSource claims.
- If a claim shows no payment, wait at least 30 days from the first submission before you resubmit it, and put the resubmission code and original claim number on it so it is not denied as a duplicate.
- Peach State adjudicates clean claims within 15 business days of receipt. A claim that is not clean is pended with a request for the missing information by the 15th business day, and closed by the 30th calendar day after it was pended if the information has not arrived.
- Peach State's House Bill 1234 guide says that when a denied or underpaid claim is overturned on appeal, the plan pays the additional amount plus 20 percent interest counted from 15 days after it received the claim.
- This page covers claims billed to the Georgia Families CMOs. Peach State's manual points to the Department of Community Health's Part II Policies and Procedures manuals for the fee-for-service program, so use the DCH manuals for a fee-for-service member.
FAQ
Questions about Georgia Medicaid deadlines
What is the Georgia Medicaid timely filing limit at the CMOs?
How long do I have to resubmit a denied Georgia Families claim?
How long do I have to appeal a Peach State claim denial?
What if another insurer is primary?
Do Amerigroup and CareSource use the same limits?
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