Claims and Billing

Workgroup Mission

Provide innovative solutions that improve the timeliness and accuracy of Georgia’s Medicaid claims review, adjudication, and payments.

Upcoming Projects

OAPI FY 2022 – 2024 Strategic Goal: Relieving burdens for our stakeholders, providers, and members.

COB Crosswalk and Standardization

• Standardize the policies or provide clarity in the process for when a member has primary coverage other than Medicaid
• Compare and identify differences in payouts by cross walking each CMOs system configuration which reflect how each calculation is set in their system.

ER Triage Payments

• For hospitals which are out of network, this project will aim to create a consistent ER payment process and reduce the burden associated with having to appeal ER claims to pay at the ER rate versus the triage rate.