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 04/01/21

Download this xls file. Quarterly report for single site (If partial period only) -- Updated 04/01/21

Download this xls file. Quarterly report for multi-sites --  Updated 04/01/21

Send the completed Excel data file as an e-mail attachment to the department at nhstaffreport@dch.ga.gov.

Report Instructions

Download this pdf file. Single site instructions

Download this pdf file. Multi-site instructions

Provider Fee Payments

Effective January 11, 2020, Georgia Department of Community Health has changed the system of receiving provider fee payment from Bank of America Velocity to JP Morgan Chase PAY CONNEXION. Please use the following resources for assistance https://dch.georgia.gov/provider-fee-payment-faqs  or call 888-706-0081 or email provider.fees@dch.ga.gov.

If your facility has not received a Registration Email from provider.fees@dch.ga.gov, 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

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 09/29/20