MedStats Billing delivers end-to-end revenue cycle management built for Georgia practices. We carry providers through the 2026 Georgia Families CMO transition to CareSource, Humana, Molina and UnitedHealthcare, enforce Georgia’s 15-working-day electronic Prompt Pay deadline under O.C.G.A. § 33-24-59.14, and manage GAMMIS enrollment and State Board workers’ compensation billing across the Peach State.
Georgia’s healthcare market runs on three parallel Medicaid tracks, a 15-working-day commercial prompt-pay standard, and — through 2026 — the largest managed care transition in the state’s history. The Department of Community Health (DCH) administers coverage for roughly two million Georgians, split across fee-for-service billing through GAMMIS, Georgia Families managed care, and Georgia Families 360° for foster care. A single missed credentialing deadline during the CMO turnover can leave months of encounters unbillable.
Georgia Billing Specializations:
Georgia Families CMO Transition (2026) — Amerigroup and Peach State Health Plan are exiting as CareSource, Humana, Molina and UnitedHealthcare take over. We run parallel credentialing so your providers stay billable through the switchover.
Georgia Prompt Pay Act (O.C.G.A. § 33-24-59.5 & § 33-24-59.14) — Insurers and administrators must pay or deny clean electronic claims within 15 working days, or 30 calendar days for paper. We track submission logs and pursue the 12% annual statutory interest owed on late provider claims.
GAMMIS Enrollment & Revalidation — Fee-for-service enrollment, CMO credentialing, CAQH upkeep and revalidation deadline tracking through the Georgia Medicaid Management Information System.
Georgia Families 360° (Foster Care) — Billing under UnitedHealthcare’s separate statewide contract covering roughly 33,000 children in foster care, adoption assistance and certain juvenile justice programs.
Workers’ Compensation (O.C.G.A. § 34-9-203) — Form WC-20(a) filings priced to the State Board fee schedule updated April 1, 2026, submitted inside the one-year billing window, with appeals filed within 120 days of the EOB.
Major Georgia Commercial Payers — Direct experience with Anthem Blue Cross Blue Shield of Georgia, Aetna, Cigna, UnitedHealthcare, Kaiser Permanente of Georgia and Alliant Health Plans denial workflows.
Built to bring clarity, control and consistency to your Georgia practice’s revenue cycle.
MedStats Billing manages everything from credentialing and claims submission to denial resolution, providing complete, results-driven medical billing and RCM solutions for healthcare providers across the United States.
Georgia practices lose revenue to a specific set of state-level billing traps, most of them tied to the 2026 managed care turnover and Georgia’s own payment statutes. These are the four we eliminate:
Credentialing with a new Georgia Families CMO can take six months or longer. Practices that did not begin before the Amerigroup and Peach State wind-down face encounters that cannot be billed to any active plan.
Georgia law entitles providers to 12% annual interest when a clean electronic claim goes unpaid past 15 working days. Practices that never audit submission logs forfeit that money entirely.
Georgia runs fee-for-service through GAMMIS, Georgia Families managed care and Georgia Families 360° side by side. Billing the wrong track produces rejections that age quietly in AR.
Incorrect Form WC-20(a) submissions, or charges filed past the one-year window under O.C.G.A. § 34-9-203, are unrecoverable even when the care was fully authorized.
Insurers and administrators must pay or deny a clean electronic claim within 15 working days, or 30 calendar days for paper claims. We audit electronic submission logs so payers are held to the statutory clock.
Provider claims left unpaid past the statutory deadline accrue interest at 12% per annum. Our AR team calculates the amount owed and pursues it directly from the delinquent payer.
CareSource, Humana, Molina and UnitedHealthcare replace Amerigroup and Peach State Health Plan. We credential in parallel and route every claim to the correct plan through each stage of the cutover.
Charges must reach the carrier within one year of service and are payable within 30 days of receipt. We file Form WC-20(a) against the current State Board fee schedule and appeal inside 120 days.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursements to maximizes your revenue potential.
MedStats Billing handles GAMMIS enrollment, CMO credentialing, clean claims processing and denial resolution across Georgia, giving practices end-to-end RCM support through the state managed care transition and well beyond it.
Claims are scrubbed against Georgia Medicaid CMO and commercial payer edits before submission to drive clean first-pass reimbursement.
Rejected claims are audited immediately, appealed with complete clinical documentation, and tracked until they are paid.
Monthly reporting on collections, AR aging and denial trends keeps you fully informed on the health of your revenue cycle.
Working knowledge of Anthem Blue Cross Blue Shield of Georgia, CareSource, Humana, Molina, UnitedHealthcare and Kaiser Permanente submission protocols.
Whether you practice in Atlanta, Savannah, Augusta or Columbus, our workflows adjust seamlessly as your group grows.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, confirm Georgia Prompt Pay compliance, and stay billable through the Georgia Families CMO transition.
Under O.C.G.A. § 33-24-59.5 and § 33-24-59.14, insurers and administrators must pay or deny clean electronic claims within 15 working days, and paper claims within 30 calendar days. Provider claims unpaid past that deadline accrue 12% annual statutory interest, which our AR team calculates and recovers.
The Georgia Department of Community Health awarded new Georgia Families contracts to CareSource, Humana, Molina and UnitedHealthcare. Amerigroup and Peach State Health Plan are exiting after their procurement protests were denied in January 2026, with the prior contracts extended through June 30, 2026.
Georgia Families 360° is the statewide managed care program for children in foster care, adoption assistance and certain juvenile justice programs. UnitedHealthcare holds the contract, covering roughly 33,000 children under billing and authorization rules separate from standard Georgia Families plans.
Georgia is an at-fault state with no PIP coverage. We bill any available MedPay, coordinate with the patient’s health plan, and manage letters of protection and third-party liability claims so treatment is not written off while liability is settled.
Under O.C.G.A. § 34-9-203, charges must be submitted within one year of the date of service and are payable within 30 days of receipt. Appeals must be filed within 120 days of the payment or EOB. We file Form WC-20(a) priced to the current State Board fee schedule.
Yes. We handle GAMMIS fee-for-service enrollment, credentialing with every Georgia Families CMO, Medicare enrollment via PECOS, CAQH maintenance, and commercial enrollment with Anthem Blue Cross Blue Shield of Georgia, Aetna, Cigna and Kaiser Permanente of Georgia.
We serve practices and healthcare facilities statewide, including Atlanta, Augusta, Columbus, Savannah, Macon, Athens, Sandy Springs, Roswell, Albany and Warner Robins.
