Medical Billing Services in Georgia
In Georgia, Medicare claims go to Palmetto GBA, fee-for-service Medicaid goes to the Department of Community Health (DCH), and most Medicaid and PeachCare for Kids members are covered through the Georgia Families care management organizations. The Medicaid filing window is six months. We handle billing for Georgia practices remotely across 15+ specialties.
Who Pays Medical Claims in Georgia
The payers behind a Georgia claim.
Jurisdiction J
Georgia Part A and Part B claims go to Palmetto GBA, A/B MAC Jurisdiction J, which also covers Alabama and Tennessee. Palmetto also processes Georgia home health and hospice claims, under its Jurisdiction M contract. DME claims go to DME MAC Jurisdiction C, run by CGS Administrators.
Georgia Medicaid (DCH)
Run by the Georgia Department of Community Health, which also runs PeachCare for Kids, the state's CHIP. Claims, appeals, prior authorizations and provider enrollment documents go through the Georgia Medicaid Management Information System (GAMMIS) secure web portal at mmis.georgia.gov.
Georgia Families CMOs
DCH currently contracts with three care management organizations: Amerigroup, CareSource and Peach State Health Plan. Each one publishes its own provider manual, with its own claim, corrected-claim and appeal rules.
DCH's April 2026 notice says the CMO procurement is in the protest phase and the current contracts are extended through June 30, 2027, so the plan list may change. We confirm each patient's plan at eligibility. Commercial and Medicare Advantage plans are billed under their own contracts.
Georgia Medicaid Billing Rules to Know
From DCH's Medicaid Part I policy manual (July 2026) and CMO provider materials.
Six months after the month of service
DCH must receive a Medicaid or PeachCare for Kids claim within six months after the month the service was rendered. A visit in May is due by the end of November. The CMOs publish their own filing rules in their provider manuals.
Other insurance and Medicare
Providers must bill third parties first. If a claim was filed on time with another payer and then recouped, denied or paid short, Medicaid must receive it within three months of that notice, and never more than 12 months after the month of service. Medicare crossover claims have 12 months from the month of service.
Resubmitting denied claims
A claim denied for wrong or missing information can be resubmitted within six months of the month of service or three months of the month of the denial, whichever is later. CMOs set their own corrected-claim windows: CareSource, for example, gives 180 days from the date of service or discharge.
Sources: Georgia Medicaid/PeachCare for Kids Part I Policies and Procedures (July 2026), Chapter 200; DCH Georgia Families pages; Amerigroup timely filing policy; CareSource and Peach State Georgia provider materials; CMS Who Are the MACs.
What Makes Georgia Medical Billing Different
Where Georgia claims usually lose time.
Why six months is tighter than it sounds
Georgia Medicaid expects other insurance to be billed first, and the six months keep running while that happens unless the claim qualifies for the third-party exception. Each CMO then adds its own rules. CareSource allows 90 days from the primary payer's explanation of payment on secondary claims, capped at 12 months from service. Peach State gives 30 days to appeal after a reconsideration denial. If DCH changes the CMO lineup after the procurement, those rules change with it. We track the payer and the deadline together through A/R and denial follow-up so a late claim does not become a write-off.
What We Handle for Georgia Practices
What we take on for Georgia Medicaid, Medicare and commercial accounts.
Eligibility checks that confirm DCH fee-for-service or the patient's CMO
Prior authorization requests and tracking
Medical coding and charge review
Claims to Palmetto GBA, DCH, the Georgia Families CMOs and commercial payers
Denial management, appeals and A/R follow-up against each plan's deadlines
Payment posting, patient statements and monthly reporting
Specialties We Support in Georgia
15+ specialties served. Pick yours to see how we bill it.
Georgia Medical Billing Questions
Common questions from Georgia practices.
Who processes Medicare claims in Georgia?
Palmetto GBA handles Part A and Part B as the A/B MAC for Jurisdiction J (Alabama, Georgia and Tennessee). Home health and hospice claims go to Palmetto under Jurisdiction M. DME claims go to CGS Administrators as DME MAC Jurisdiction C.
How long do I have to file a Georgia Medicaid claim?
Six months after the month in which the service was rendered, per DCH's Part I policy manual. Medicare crossover claims get 12 months from the month of service, and claims delayed by another insurer have their own window of up to 12 months.
Which Georgia Medicaid plans do you bill?
DCH fee-for-service Medicaid and the Georgia Families CMOs (currently Amerigroup, CareSource and Peach State Health Plan), each under its own published rules.
What if another insurer denied the claim first?
Georgia requires third-party billing before Medicaid. Once the other payer denies, recoups or pays short, the Medicaid claim must reach DCH within three months of that notice, and no later than 12 months after the month of service. A CMO may use a different window, so we check the plan's manual.
Which specialties do you support for Georgia practices?
Behavioral health, laboratory, home health, hospice, infusion, sleep medicine, DME, dental, vision and ENT are among the 15+ specialties we support for Georgia practices.
Can Salyx RCM bill for my Georgia practice remotely?
Yes. The work happens remotely and securely, inside whichever billing or practice management software your Georgia practice already uses.
Check Your Georgia Claims Before the Six Months Run Out
Start with a free billing audit: a review of your recent claims, denials and A/R, with a summary of what we found.