Effective August 1, 2015, Georgia’s Department of Community Health (DCH) will implement a NCQA certified Centralized Credentialing Verification Process utilizing a Credentialing Verification Organization (CVO). The new functionality will be added to the Georgia Medicaid Management Information System (GAMMIS) website (www.MMIS.georgia.gov) and will streamline the time frame that it takes for a provider to be fully credentialed.
Credentialing and recredentialing services will be provided for Medicaid providers enrolled in Georgia Families and/or the Georgia Families 360° program.
This new streamlined process will result in administrative simplification thereby preventing inconsistencies, as well as the need for a provider to be credentialed or recredentialed multiple times.
The CVO’s one-source application process will:
- Save time
- Increase efficiency
- Eliminate duplication of data needed for multiple CMOs
- Shorten the time period for providers to receive credentialing and recredentialing decisions
The CVO will perform primary source verification, check federal and state databases, obtain information from Medicare's Provider Enrollment Chain Ownership System (PECOS), check required medical malpractice insurance, confirm Drug Enforcement Agency (DEA) numbers, etc. A Credentialing Committee will render a decision regarding the provider's credentialing status. Applications that contain all required credentialing and recredentialing materials at the time of submission will receive a decision within 45 calendar days. Incomplete applications that do not contain all required credentialing documents will be returned to the provider with a request to supplement all missing materials. Incomplete applications may result in a delayed credentialing or recredentialing decision. The credentialing decision will be provided to the CMOs.
HP provider reps will provide training and assistance as needed. Beginning August 1, 2015, providers may contact HP for assistance with credentialing and recredentialing by dialing 1-800-766-4456.
There will be a transition period for the new CVO. The transition period is as follows:
- Effective August 1, 2015, all new provider applications seeking enrollment with one or more CMOs will be credentialed through the new CVO.
- From August 1, 2015 through November 30, 2015, the CMOs will continue to process all existing applications seeking initial credentialing for those providers that submitted an application prior to August 1, 2015.
- From August 1, 2015 through November 30, 2015, the CMOs will continue to recredential all providers currently enrolled in their respective health plans.
- Effective December 1, 2015, all providers will be credentialed and recredentialed through the new CVO. Beginning December 1, 2015, the CMOs will no longer perform credentialing or recredentialing services for enrolled providers.
The CMOs will be responsible for the delegated credentialing and recredentialing for Independent Practice Associations (IPA) and Provider Hospital Organizations (PHO).
If you have additional questions, please review the Frequently Asked Questions (FAQs) posted on the DCH website.
Questions regarding contracting should be addressed directly to the CMO at the following:
|CMO Name||Provider Services||Website|
|Peach State Health||1-866-874-0633||https://www.pshpgeorgia.com/||[email protected]|