Recovery of Medical Assistance from Third Party; certain provisions to comply with federal law; revise

Stronger payment protections for Medicaid claims

Georgia strengthens rules for collecting payments from insurers and other payers responsible for Medicaid patients’ care. Covered payers include employer health plans, managed care plans, and pharmacy benefit managers. They must help the Department of Community Health check coverage and answer payment inquiries within three years after care. They must accept the department’s payment authorization and cannot deny payment solely because prior approval was missing. They must answer claim-status inquiries within 60 days and follow state payment deadlines, with interest owed for late payments. They must share eligibility and claims payment data quarterly and accept transfers of rights to third-party payments. They cannot deny department claims solely for submission dates, claim format, or missing documentation at the point of sale. That protection requires filing within three years after care and starting enforcement within six years after the claim’s submission. The authorization, 60-day response, quarterly data, payment-rights transfer, and claim-denial protections apply to plans issued, issued for delivery, delivered, or renewed on or after April 28, 2001.