Georgia Medicaid Auths for SLPs, OTs and PTs, Referring Physician denials and other updates
Georgia Medicaid changed their authorization system this week to require everyone to answer the questions at the bottom of the page. There were some questions on the last question that states
"Is this PA shared with another provider?"
I got an answer back from contact us just now stating that it's referring to the auth being shared between clinics, sharing the auth with another tax id:
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CareSource has been reprocessing claims that were denied due errors recently. There were some complications with some claims with the group NPI process. If you're finding you still have claims that haven't been reprocessed, make sure you resubmit if they didn't make it thru the clearing house. Otherwise, remember appeal claims that were denied, and dispute if there was some payment made.
If you have not applied for your Group NPI notification application on GAMMIS and you use the Group NPI in credentialing, do it as soon as possible. CMS has delayed some of the requirements, but you're going to run out of time if you don't get this done.
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Make sure the referring physicians you are using are active with Medicaid. I've caught several claims the last couple of months rejecting because of this issue. Some of the pediatricians didn't reactivate in time, and it seems Medicaid termed some of them starting in July.
To check, go to GAMMIS and click:
Provider enrollment, provider contract status
Enter the NPI for the referring physician
There should be a list of locations that the referring dr has connected to their NPI, click on the address that you know the provider to be referring from:
It should reflect active on the next page:
However some are showing terminated:
If that is the case, make sure you contact the office to ask what the situation is and if another physician who is active can refer the patient instead.
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Make sure your software is updated with your location NPI to print in box 32. I see that CMS delayed this requirement to 1/1/27 as it was previously to be enforced 8/1/2026. See banner message from 08/31/2026 on GAMMIS. I'll post a separate blog about it as it's a lot of info to list.
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I've been asked a lot about the upcoming changes for Speech. I don't have much to comment on other than Medicaid stated they would annouce info in October/November. Hopefully all the feedback SLPs have given will keep rates high enough. They're trying to restructure the system of not using RVUs (relative value units) based on time, but I hope the structure is the best interest of the provider with the outcome. Make sure you continue to contact your local representatives in congress. Also pay attention to CMS.GOV for official changes.
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ABA:
There are some policy changes for ABA coming up. Make sure you pay attention to the quarterly published manuals and banner messages in GAMMIS. Here's the statement:
Effective on 10/01/2026 The Department of Community Health will implement the following policy updates for the delivery and reimbursement of ABA therapy in alignment with the goal of ensuring member access to needed services while continuing our efforts to reduce fraud, waste, and abuse:
Under 601.1.2 will be updated to read
To enroll as a BCBA/BCBA-D Medicaid provider, the practitioner must maintain an active certification issued by the BACB and hold a valid license from the Georgia Behavior Analyst Licensing Board.
Under 1063.1 the following will be added
Supervision does not require the supervisor to be present at the work site with the supervisee, but the provision of in-person supervision must be performed at a frequency to ensure quality of the services being provided.
New section under 903 Assessment and Service Descriptions: Assessment Descriptions
903.3 Telehealth Services
The Telehealth Readiness Checklist must be completed prior to the provision of an assessment, reassessment or treatment if conducted via telehealth. Providers conducting more than 25% of assessments via telehealth and/or 50% of units of service via telehealth are subject to an increased frequency of audits to ensure appropriate oversight of supervisees is occurring and appropriate care for members is being provided.
Treatment Limits: Providers demonstrating multiple prior authorization requests for service utilization greater than 30 hours will be subject to increased audit frequency.
Registered Behavioral Technician (RBT) Oversight: All ABA providers will be subject to a desk review to audit compliance with RBT oversight standards as outlined under The Behavioral Analyst Certification Board (BACBC) and DCH Policy.
If non-compliance with established standards is identified, the provider is subject to: increased reporting requirements, minimum required supervision ratios as established by the department and focuses claims review.
Required Report on Abandonment of Care: An ABA Annual report will be submitted to DCH (and may be reported, publicly, pending PHI removal) to highlight the number of cases abandoned by the provider each year for acuity or if no reason is provided. A template for the required elements for the report will be provided no later than January 1, 2027, and the first report will be due on or before February 1, 2028, covering the time period from January 1, 2027, through December 31, 2027.
Solicitation: In accordance with Policies and Procedures for Medicaid PeachCare for Kids, Section 106.5, the practice of soliciting members is prohibited. DCH will refer any reported/suspected solicitation to Office of Inspector General (OIG) for investigation and upon verification suspend member placement of ABA providers who are or have been involved in the solicitation of members.
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Lastly, there's a Medicaid conference that I'm sure many will attend on October 29th in Atlanta. I'll send any updates and share of course anything you learn as well.
Thanks for all you do for your patients and community!
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