Medical Billing Services in Georgia
Billing, coding, credentialing and denial management for Georgia practices, with Medicare claims through Palmetto GBA (Jurisdiction JJ) and Georgia Medicaid handled by people who know the rules.
Medical billing for Georgia practices
Georgia practices bill a split market. Metro Atlanta clinics see a heavy commercial and Medicare Advantage mix, while practices in South and Middle Georgia often depend on Georgia Medicaid, PeachCare for Kids and Medicare. Most Medicaid members are enrolled with a care management organization, and a contested CMO procurement is still pending, so plan assignments and contracts are expected to change once the state names the new plans.
SFA Solutions works with Georgia practices remotely. We bill Medicare Part B through Palmetto GBA, work CMO claims and denials, keep your enrollment current across plans, and submit most clean claims within 24 hours. Georgia Medicaid has one of the shorter filing windows in the country, so speed at charge entry and follow-up matters more here than in many states.
Georgia at a glance
| Medicare contractor | Palmetto GBA, Jurisdiction JJ |
|---|---|
| Medicaid timely filing | 6 months from the month of service for primary claims; 12 months from the month of service for claims where Medicaid is secondary |
| NP practice authority | Restricted |
| Cities we serve | Atlanta, Augusta, Columbus, Macon, Savannah, Athens, Sandy Springs, Roswell, Albany, Valdosta |
What Georgia billing involves
These are the programs and rules our team works with for Georgia claims.
Medicare
Palmetto GBA · JJGeorgia Part B claims are processed by Palmetto GBA in Jurisdiction JJ. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Georgia Medicaid
Georgia Medicaid (Georgia Families managed care); PeachCare for Kids (CHIP); Georgia Pathways to Coverage for qualifying adults
Portal: Georgia Medicaid Management Information System (GAMMIS) web portal, administered for the Department of Community Health by fiscal agent Gainwell Technologies
Medicaid managed care
Georgia Families members are currently served by three CMOs: Amerigroup Community Care, CareSource and Peach State Health Plan. In December 2024 the state issued a notice of intent to award new contracts to CareSource, Humana, Molina Healthcare and UnitedHealthcare, and the award is still in the protest phase. The Department of Community Health has extended the current CMO contracts through June 30, 2027, so check the state's Georgia Families news page for the transition timeline.
Timely filing
6 months from the month of service for primary claims; 12 months from the month of service for claims where Medicaid is secondary.
Commercial and Medicare Advantage
Anthem Blue Cross and Blue Shield of Georgia, UnitedHealthcare, Aetna, Cigna and Kaiser Permanente of Georgia are the major commercial carriers. Humana, UnitedHealthcare and Aetna hold large Medicare Advantage enrollment.
Prompt pay law
Under O.C.G.A. 33-24-59.14, insurers must pay or deny clean claims within 15 working days for electronic claims and 30 calendar days for paper claims, with interest of 12% per year on late payments.
Nurse practitioners
Restricted practiceGeorgia NPs practice under a protocol agreement with a delegating physician, and a physician can generally delegate to a combined total of eight APRNs and physician assistants at one time. Payer enrollment usually asks for the protocol agreement and the delegating physician's details, so keep both current before credentialing.
Credentialing
New Georgia Medicaid providers enroll through the GAMMIS portal before any CMO will load them, and each CMO then adds you to its network, so one accurate Medicaid file helps prevent name, address and taxonomy mismatches across plans. Most commercial payers, including Anthem and UnitedHealthcare, pull from CAQH ProView, so keep your attestation current every 120 days.
Billing challenges Georgia practices face
A six month Medicaid filing window
Georgia Medicaid allows six months from the month of service for primary claims, which is far shorter than Medicare's 12 months. Claims that sit in a work queue or bounce on an eligibility edit can age out quickly. Most clean claims are submitted within 24 hours, and we work rejections daily to keep claims well inside the limit.
CMO changes and plan assignment
With new CMO contracts still in the protest phase, patients may move between Amerigroup, CareSource, Peach State and new plans. Billing the wrong plan creates denials that eat into the filing window. We verify eligibility and plan assignment in GAMMIS before each visit.
Supervised NP billing
Because Georgia NPs work under protocol agreements, payer rules for NP billing vary. Some commercial plans pay NP services at a reduced rate, and Medicare incident-to rules apply only when strict supervision requirements are met. We match each claim to the right rendering provider and payer policy.
Our services in Georgia
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Georgia
Georgia medical billing questions
What is the timely filing limit for Georgia Medicaid?
Georgia Medicaid requires primary claims within six months from the month of service. When Medicaid is the secondary payer, the window is 12 months from the month of service. CMOs set their own rules, so check each CMO's provider manual.
Who is the Medicare contractor for Georgia?
Palmetto GBA processes Medicare Part A and Part B claims in Georgia as the Jurisdiction J (JJ) A/B MAC. Provider enrollment changes go through PECOS, and Palmetto GBA's portal handles eligibility, claim status and redetermination requests.
How fast must Georgia insurers pay clean claims?
Georgia's prompt pay statute, O.C.G.A. 33-24-59.14, requires payment or denial within 15 working days for electronic clean claims and 30 calendar days for paper claims. Late payments carry interest of 12% per year under the statute. Self-funded employer plans follow federal rules instead.
Can SFA Solutions bill for my Georgia practice remotely?
Yes. We work inside your existing EHR or practice management system remotely and handle charge entry, claim submission, denials and A/R follow-up for Georgia practices. We can typically begin within 24 hours of receiving system access.
Get a free billing audit for your Georgia practice
We will review your recent claims and denials against Georgia payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction J (JJ)
- Georgia Medicaid: Care Management Organizations
- Georgia Families latest news (CMO procurement status)
- Georgia Medicaid Part I policy review (timely filing)
- Georgia OCI Bulletin 21-EX-2 (prompt pay statutes, O.C.G.A. 33-24-59.14)
- Georgia Composite Medical Board APRN information summary
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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