Georgia Medicaid Updates for Therapists
- Dianna Watkins
- 7 days ago
- 6 min read
Welcome to May everyone, at least we made it to here.
I'm trying to design a website that will centrally have a location that we can all discuss things that are going on because there have been so many changes and they keep coming fast these last 4 months. But stay tune for that for now ...
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Physical and Occupational Therapists: If you didn't upload your license to GAMMIS when you renewed, do so asap. Medicaid suspended all of the Physical Therapists who did not do so on 4/26/2026.
If you didn't and you're showing suspended under the demographic maintenance section:
Then follow these steps.
Go to providers, change of information.
Then click credentials and reactivation of participation boxes. You have to put today's date, nothing earlier.
Walk thru the steps and upload the state license. Medicaid stated to me today it will take 15 business days, will be retro to the day it was submitted. You can sometimes after approval as for the eligibility to be retro'd but I'm not sure if that will be a possibility yet.
If you're not suspended under demographic maintenance, then simply check the box credentials only and walk thru the steps to upload your license. (OTs here's your warning to do this now)
LET ME STATE THAT EVEN THOUGH THERE WAS A LETTER SENT OUT TO REMIND PROVIDERS TO UPDATE THEIR LICENSE AND AT THE BOTTOM IT WAS ADDED TO UPLOAD THESE LICENSES ONLINE, A LOT OF US DIDN'T RESPOND TO THIS BECAUSE IN THE PAST THEY WOULD SENT OUT THIS NOTICE THEN REJECT IT WHEN WE TRIED. FOR THE PAST AT LEAST 10 YEARS THE LICENSING BOARD WOULD COMMUNICATE AND UPDATE THE LICENSE FOR US WITH DCH. IF THEY HAD NOT REJECTED THE UPDATES IN THE PAST, WE WOULD NOT BE IN THIS SITUATION WITH A LOT OF PROVIDERS SUSPENDED.
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I didn't attend the Medicaid conference. I have cliff notes from providers that did. Notes from that conference:
DCH knows everyone is mad about the rates but they can't control CMO rates.
PSHP and CareSource - certified letters should be addressed to the contact on the letters received. Letters need to state your wait list number, how clinics in your area for a distance have a waitlist, can't operate at the rate quoted, focus on the member need as much as possible. MORE LETTERS mean more tracking of the issue for data purposes. Even if it doesn't bring immediate change at least they will know of the complaint.
I'm attaching a list that was being passed around of contacts. I do not know if all of these contacts are correct, so at your digression....
Supposedly the CMOs are hearing from response before doing anything. CareSource stated they were needing response to help possibly obtain funding for 2027 (dangled the carrot)
DCH knows of the changes for 92507 and said look for banner messages about the change in Nov/Dec
Their new website GA Care Connect will possibly be up by the end of this year, early next year.
Group Medicaid applications must be done before June. These are for practices of 2 or more providers under a tax id.
If you decide to not continue with the contract with Caresource's rate on 5/11, you must respond to the letter stating so. You will be in network at the Medicaid rate for 90 days, then termed.
Make sure you are constantly staying on top of your revalidation with Medicaid. There will not be much forgiveness in the future if you don't revalidate by their deadline. MAKE SURE YOU ARE CHECKING YOUR LOGIN ON GAMMIS OFTEN. I have been catching lately that the Y at the end of the line to state the revalidation is due for a provider is not showing up for ones that are due.
See this example:
Some that are on this list from this screenshot actually need to be revalidated. Yet it doesn't have a "Y" at the end to let us know such.
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Onesource is now doing auths for CareSource as of 5/1/2026. SPEECH - make sure you're getting hearing screens for every child now that this change is in place.
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IF you are using AI for any documentation, you must have your patient acknowledge that AI is being used. Some software include this in their intake forms, but for most providers they create their own intake forms and have not included this info. Amerigroup recently put out a bulletin restating this as well....
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ABA providers - make sure you're always checking for the latest cover sheet in the Medicaid manual for auths. There's a new one for April. Medicaid now wants authorizations to include the re-evaluation auths and that time frame addressed with any authorizations going forward. You are only allowed 2 appeals before you have to submit a new auth request now. Make sure you have all docs in order before making that second request. Also you can use the contact us feature on GAMMIS to ask someone to review the docs before you submit the appeal.
PT, OT, SLP - You are only allowed 2 appeals before you have to submit a new auth request now for straight Medicaid requests. Make sure you have all docs in order before making that second request. Also you can use the contact us feature on GAMMIS to ask someone to review the docs before you submit the appeal.
Always make sure your signature date is within 30 days of the physician's date. If it isn't, change your date.
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CHAMPVA is having a huge over hall for eligibility within their systems therefore many many claims are not being processed. Claims come back rejected as member not eligible or found. CHAMP doesn't know how long this will take, they already have a problem with taking forever to process claims so this is making the delay worse. You can call with the member to have CHAMP expedite the member, but don't expect that to move that much faster.
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CareSource continues to deny 92507 and 92609 due to a NCCI edit yet all other insurances including commercial actually pay the codes on the same date. If you're receiving these rejections, complain to DCH here:
This is an email to complain to DCH that the CMO isn't helping you with something. DO NOT ABUSE THIS EMAIL. Only use it when you really really need help or they really really need to be reported and haven't responded to you with multiple requests. With these claims for speech that CareSource denies, you can submit the denial screenshot to DCH (be aware of HIPAA info) to show examples of claims they're denying that Medicaid normally would pay.
For Medicaid and CMOs, you should bill like this:
92507 59, GN, HA
92609 U1, HA
For commercial insurances:
92507 59, GN, HA
92609 GN, HA
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Most OTs are performing sensory. I would highly recommend you review your caseload and add a sensory goal with the coding 97533 onto your plan of care IF it is something the patient needs. Sensory is NOT a family code, so you will need specific authorization for this CPT. At least 1 unit of 97533 with 3 units of 97530 per session for something you're already doing to bring up your revenue and code correctly for these changes we're facing. IF the CMO (pshp) states you don't need the extra auth/code added, still you've shown paperwork to report that going forward you will be addressing this goal. Speech can also bill for sensory goals, but understand the coding and if the child is being addressed for sensory already with OT. Commercial and AG doesn't usually allow for 97533
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BCW has been gracious enough to pay the difference of the Medicaid rate of the proposed CMO reductions, but I hate to see that funding taken out of DPH. I wish the CMOs would have came back to us with an offer such as "we're reducing but now you can have PTAs, COTAs and SLPAs work with our members" or "allow members to be seen in groups" to help combat the reduction. Nothing was offered, just simply take it or leave it.
The understanding is that many clinics are going to reject the proposal and go out of network. It's not possible for BCW providers to do it since they have to be in 2 CMOs. It's also hard to band together to do such a thing financially when everyone was hurting already.
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There's a lot of more I'm sure I've missed. It feels like it's almost everyday there's another change and it's been hard to send out an update because of the quick changes.
As always, thank you for all you do for the community. Especially as we embrace all the new changes this year.
Dianna Watkins
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