Enrolled in Medicaid

Filing Instructions for nursing homes enrolled in Medicaid

NOTE: Due to the passcode saving problems being experienced with the Single Site report, a new template report is available (Version 11).

The files available below provide information about current reporting requirements and instructions for how provider fees should be paid.

Report Formats

NOTE: Clicking on the documents may open them in a new browser window. To download the files to your hard drive, right-click the file (Control-click on Macintosh) and choose "Save Target As...". 

Download this xls file. Quarterly report for single site  -- Updated 10/08/24

Download this xls file. Quarterly report for single site (If partial period only) -- Updated 10/08/24

Download this xls file. Quarterly report for multi-sites --  Updated 10/08/24

Send the completed Excel data file as an e-mail attachment to the department at [email protected].

Report Instructions

Download this pdf file. Single site instructions

Download this pdf file. Multi-site instructions

Provider Fee Payments

Effective June 10, 2024, Georgia Department of Community Health has changed the system of receiving provider fee payment from JP Morgan Chase PAY CONNEXION to JP Morgan PAYMENTUS. Please use the following resources for assistance, Customer Portal Guide or call 888-706-0081 or email [email protected].

If your facility has not received a Registration Email from [email protected], please submit the Sign-up Form below.

This file includes the forms needed to set up the electronic funds transfer for payment of provider fee payments. The forms may also be used to make changes to facility name, home office name, contact person, and bank information related to provider fee payments (only).

Download this pdf file. JPMorgan Chase PAY CONNECT Sign-Up Sheet  - Updated 01/04/21

Download this pdf file. Customer Portal – User Guide V1.1 - Posted 07/12/24

If your facility chooses to mail in your provider fee payment, please send to the lockbox address below:

Nursing Home Fees

P.O. Box 734654

Dallas, TX 75373-4656

Notate on checks that the payment is for NH Provider Fees and the provider name. 

Contact Information

If you have any questions about the provider fee program or reporting requirements, please consult the below directory and contact the person designated for the subject of your questions.

Download this pdf file. Directory of Contacts in Medicaid - Updated 02/27/23