Medicaid
Advocacy Win for Pediatricians: Georgia Medicaid Updates its EPSDT
Health Check program in reporting Sick & Well Visits
When providing a preventive health visit (CPT codes 99381-99385, 99391-99395) an abnormality is encountered or a preexisting problem is addressed during the preventive visit, and if the problem/
Prior to this, DCH/Medicaid policy limited reporting to no higher than a 99212 with a well visit. We are very excited that DCH/Medicaid has now updated its policies to reflect new coding guidelines within Medicaid Fee for Service the three Georgia Medicaid Care Managment Organizations.
Virtual Medicaid Office Hours
First Thursday Medicaid Office Hours – Join Medicaid Task Force Chair, April Hartman, MD on the first Thursday of every month from 8:00 am – 9:00 am for a comprehensive discussion on all things Georgia Medicaid. Save this link in your calendar to join the event each month.
Discussion will include information from GAMMIS to learning about any individual concerns facing your practice and everything in between. Please join us or consider having your practice administrator or billing staff participate in this event.
Early, Periodic, Screening, Diagnostic, & Treatment (EPSDT)
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) – Health Check Serviceds is designed to assure that children under age 21 receive early detection and care, so that health problems are averted or diagnosed and treated as early as possible. The EPSDT benefit is also available to children enrolled in PeachCare for Kids® members. This program provides coverage of medically necessary diagnostic services.
Billing Tips for Health Check
The Early Periodic Screening Diagnosis & Treatment – Health Check Services manual is updated quarterly in January, April, July and October each year and can be downloaded off the Medicaid web portal under the tab Provider Manuals. The following are tips to guide you when billing for Health Check Services with FFS.
- Follow the periodicity schedule and check for up dates at AAP/Bright Futures Periodicity Schedule.
- Review quarterly updates within the EPSDT – Health Check Services manual posted on the Medicaid webportal.
- If you have any concerns related to EPSDT services, please contact Fozia Khan Eskew at the Chapter office at feskew@gaaap.org.
Who are the Managed Care Organizations?
Enrollment in a Georgia Medicaid
Children and those who legally blind or disabled are among the residents in Georgia who may be eligible for Medicaid (sometimes referred to as Medical Assistance). Georgia Families can assists in identifying a Georgia Medicaid Care Management Organization (CMO) for a child. Those wishing to enroll in Medicaid can call 1-888-GA-ENROLL (1-888-423-6765) for details.
What are the current Georgia Medicaid Care Management Plans?
Checking Medicaid CMO Eligibility
With the implementation of HB 1234 in 2008, there have been some changes to the way you verify member eligibility. Practices are encouraged to verify a child’s eligibility, especially on the date of service, via the GAMMIS website. This confirmation of eligiblity can be printed and retained as proof of eligibility.
Planning for Healthy Babies
Planning for Health Babies (P4HB) is a waiver program with the goal of reducing the number of low birth weight (LBW) and very low birth weight (VLBW) births in Georgia. This program provides Family Planning, Inter-Pregnancy Care (IPC) and Recourse Mother (case management) services to members 18 through 44, who would otherwise not be eligible for Medicaid. For further details click here.
Georgia Pathways to Coverage™
Georgia Pathways to Coverage is a new program to help low-income Georgians qualify for Medicaid who otherwise would not be eligible for traditional Medicaid.Unlike traditional Georgia Medicaid programs, Pathways requires monthly reporting of qualifying activities for continued eligibility. For more click here; for details on how to apply click here.
The Georgia Chapter of the American Academy of Pediatrics is incorporated in the state of Georgia.