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DEDICATED TO THE HEALTH OF ALL CHILDREN Winner of Outstanding Chapter Award 1966, 1996, 2000 & 2004 |
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DEDICATED TO THE HEALTH OF ALL CHILDREN Winner of Outstanding Chapter Award 1966, 1996, 2000 & 2004 |
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Medicaid
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Medicaid Rates to Change July 1, 2008, Pending Governor's Signature: In the FY 09 budget, which was approved by the Georgia General Assembly in April, Medicaid rates were increased to 80% of the 2007 Medicare fee schedule. Assuming Governor Perdue's signature, this will be the first increase in Medicaid payment rates to physicians in six years. The Governor must sign or veto parts of the budget May 23rd, and we expect him to approve the new Medicaid rates. Also, rates on Healthchecks were also increased by 2.5%. Here is a sampling of the new rates on some common CPT codes:
Also, as part of the action of the General Assembly, the Medicaid CMO's are required also to observe, i.e. pay, these new rates. Members should review their contracts with the CMOs to review how their reimbursement is described. Medicaid CMOs: Many members continue to have problems and issues with the Medicaid CMO's, who are entering their third year of handling the Medicaid and Peachcare programs in Georgia. While we don't have a staffer at the Chapter office dedicated solely to helping with Medicaid issues, we want to do our best to help members with these critical issues. We would ask that you email your questions/issues to medicaidquestions@gaaap.org and we will respond to them via that route. We have some of your physician leaders who can answer these questions and Chapter staff can assist in certain areas, especially on immunization or Healthcheck questions. The Chapter completed, in May of 2007, a report on Access to care for children in the Medicaid and Peachcare programs. Both of these programs have undergone significant changes in the past two years and as such, in many instances access to care has diminished. The study includes a survey of several Georgia communities on the availability of pediatric providers. Click here for a complete copy of the report. The
Centers for Medicare and Medicaid Services (formally know as HCFA)
administers the Medicaid Program at the Federal level. The Georgia
Division of Medical Assistance (DMA), an entity within the Department of
Community Health, administers Georgia’s Medicaid program. Medicaid
covers pregnant women, children under 1 year, children between 1 and
six years and children between 6 and 19 based on financial eligibility. Eligibility screens are
performed at county offices of the Department of Family and Children
Services (DFCS), a unit of the Dept. of Human Resources (DHR). The following information can be downloaded from the Provider section of the GHP website.
Medicaid
Provider Manuals PeachCare for Kids If you are aware of children who do not have health insurance, they may be eligible for coverage under this program. Families may call 1-877-GA-PEACH to request an application or complete the application online at www.peachcare.org. Physician's offices may request PeachCare applications by calling the toll free number. Another resource for information about PeachCare is the Covering Kids Initiative in Georgia (www.coveringkids.org). This program offers a simple tool to determine eligibility and as well as an information booklet. Spanish speaking families can apply online in their native language. The new Spanish version has the same information as the English version including the ability to apply directly online. Using the Spanish version of the website, which is easily accessible from the PeachCare homepage www.peachcare.org, parents can access PeachCare benefits information, eligibility requirements and a real time application which takes only about 10 minutes to complete. Three Month Lock Out Peach Care for Kids members are subject to a three-month waiting period for eligibility coverage if their premiums are not received by the 1st of the following month. Example:
Also note, the waiting period for PeachCare for Kids coverage for parents who voluntarily terminate coverage of private insurance is six months. Payment Options for PeachCare for Kids
There are now additional payment options available to parents of PeachCare for Kids to ensure their premiums are received timely. Members can begin paying their premiums via the following methods:
1. Telephone or Internet access using a credit or debit card 2. Automatic account withdrawal 3. Premium payment booklets for mail service
Members log onto the password protected "my account" of www.peachcare.org to view their account information, pay premiums, update their contact information, check the status of premium payments and verify monthly payments. Members can also use their credit or debit cards for payment by calling (877) 427-3224.
Who is included in Medicaid Managed Care?: In June 2006 Georgia Healthy Families transitioned low income families, transitional Medicaid, children, pregnant women (presumptive and Right from the Start Medicaid), women eligible for Medicaid due to breast and cervical cancer and PeachCare for Kids to managed care. Aged, Blind and Disabled (ABD) population and Foster Care children are not included in managed care at this time. Who are the Managed Care Organizations?:
How your patients can enroll in Georgia Healthy Families
Maximus, the enrollment broker for GA Healthy Families, works with Medicaid members who are eligible to participate in the GHF program.
Members are encouraged to do the following to enroll: 1. By calling 1-888-GA-ENROLL (1-888-423-6765) 2.
On line at www.gahealthyfamilies.com 3.
By completing an
enrollment packet and mailing it to GHF 4.
Attending an
assisted enrollment session
Once a member has enrolled into a plan, they will have 90 calendar
days to change their health plan or PCP.
After the 90-day period, they will not be able to make any changes
to their health plan affiliation without cause until the open enrollment
period begins the following year. To
assist you and your patients in the enrollment process, there are a few
things you should know:
Provider’s can work with CMOs to be sure their practice group name and their individual provider names are listed in such a way that the families who receive care from these providers will be able to find them as easily as possible in the directory. (i.e., Maximus will receive the info on how to list the practices and the providers from the CMOs)
Georgia Health Partnership - ACS Affiliated Computer Services (ACS) is an electronic healthcare administrative system. ACS will still function as the DCH's third party administrator for Georgia Medicaid and PeachCare for Kids that are excluded from the Georgia Healthy Families (GHF) program.
ACS Claims Assistance Meetings
ACS conducts claims assistance meetings designed to give you one on one assistance with any claims problems you may be experiencing. Meetings will be held by appointment only from 8:00am-4:30pm. Time slots are limited to an hour and a half and are reserved for those who register. You can register on line at www.time2reg.com/ghpconferences or by calling (877) 660-2080. For future scheduled meetings, please click here.
The Medicaid Health Check (formerly EPSDT) program is Georgia’s well child preventive health care program for Medicaid-eligible children birth to 21 years of age and PeachCare-eligible children birth to 18 years of age. It is the Early and Periodic Screening, EPS component of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. Georgia Medicaid provides and reimburses the Diagnostic and Treatment aspect of EPSDT services under other programs (such as Laboratory, Children Intervention Services (CIS), Physicians, Hospitals, Home Health, etc). Health Check Program is HIPAA compliant The Health Check program will include the following changes/additions. This list is not inclusive of all changed. The complete list of changes are located in the October 1, 2005 Health Check manual now available on the web at www.ghp.georgia.gov.
EPSDT Referral Codes- You are now required to use the HIPAA Compliant referral codes. Listed below are the acronyms and descriptions of the Health Check referral codes. In box 19 of the CMS 1500 form, document if a referral was made by indicating "N" for no or "Y" for yes. Then document one of the following:
Please click here for complete cross walk instructions for WINASAP, CMS 1500 forms or the Web Portal.
Lead Assessment
TB Risk Assessment-
Please
click here to view the TB
Risk Assessment Form.
Reviewing
your Health
Check Record Medicaid and PeachCare for Kids Enrollment The quickest and easiest way to become a Medicaid and PeachCare provider would be to apply online at www.ghp.georgia.gov. Start by accessing the Provider Information Tab, under the "Enroll as an Individual" link. Once you've completed the online application, you will receive a confirmation number. Be sure to attach this confirmation number to the requested documents and mail them via certified mail to GHP. Georgia Health Partnership (GHP) Each provider must enroll separately. The Effective date of enrollment will be the first day of the month in which the completed application is received by GHP or the effective date of any required license, whichever is later. If you would like an application mailed to you, call the Provider Enrollment unit at GHP, 404-298-1228, or 1-800-766-4456. You can also Click Here to print a copy of the application. Helpful Hint: If you are mailing your application to GHP, Click Here for a Physician Services check list, to ensure you have all the required documentation. When adding an additional location, completing an entire application is not necessary. An abbreviated coversheet entitled "Additional Location for Individual Practitioner" is available. Click Here to print a copy of the abbreviated form. When adding a provider to an existing group, as long as the provider already has a Georgia Medicaid number, you will only need to complete an "Additional Location (DMA-005)" form. Click Here to print a copy of this form. Be sure to write the payee number on the cover sheet. This will help link the new provider number to the group. (You will also avoid the need for and FTE or W9) When starting your own practice, as long as the provider already has a Georgia Medicaid number, you will only need to complete an "Additional Location (DMA-005)" form. A power of attorney is also needed. When changing information, such as telephone numbers, EPO status, etc. you will need to complete a "Change of Information Form". Click Here to print a copy of the form and instruction sheet.
Enrolling into Georgia Better
Health Care (GBHC)
Enrolling into GBHC will allow member
to choose you as their primary care provider. You can find application
online at www.ghp.georgia.gov
under the Provider Information Tab, under the "enroll as a GBHC
group" link. NOTE: This process can take up to 180 days.
Enrolling into Health Check COS In order to be a Health Check provider, you will need to first enroll into Vaccine for Children (VFC) program. You can contact them directly at (404) 657-5013 or (800) 848-3868 and ask that an enrollment package be mailed to you. Next, you will need to enroll in Health Check category of service in order to perform well child exams. Click Here for the equipment verification form. Mail this form, along with your acceptance letter, into the VFC program to GHP. Georgia Health Partnership (GHP) NOTE: Your Health Check effective date can be retro-active back to the same effective date as your VFC if necessary. Click Here for the most Frequently Asked Questions regarding Enrollment. For questions or concerns call (404) 881-5089. |
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