Title 33 — Title 33
0 chapters · 1,218 sections in this title.
O.C.G.A. § 33-21A-1 Short title
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This chapter shall be known and may be cited as the ‘‘Medicaid Care Management Organizations Act.’’ History. — Code 1981, § 33-21A-1, enacted by Ga. L. 2008, p. 704, § 1/HB 1234. 33-21A-2. Definitions.
O.C.G.A. § 33-21A-11 Medical malpractice judgments
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Payment by insurer, §33-3-27. Pharmacy benefits managers. Differences between reimbursed amounts and amounts charged to health plan, §33-64-10. Imposing certain fees or engaging in practice of steering, §33-64-12. REPUDIATION. Insurance contracts. Minors, §33-24-5. RESCISSION. Lif…
O.C.G.A. § 33-21A-12 Rural health care providers
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Essential rural health care provider access, §§33-20B-1 to 33-20B-6. HEALTH BENEFIT PLANS. Health insurance navigators. Compensation from insurers, health benefit plans, businesses, etc. Restrictions, §33-23-203. HEALTH CARE CORPORATIONS. Health maintenance organizations. Organiza…
O.C.G.A. § 33-21A-2 Definitions
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As used in this chapter, the term: (1) ‘‘Care management organization’’ means an entity that is organized for the purpose of providing or arranging health care, which has been granted a certificate of authority by the Commissioner of Insurance as a health maintenance organization …
O.C.G.A. § 33-21A-4 Reimbursement for emergency health care services
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(a) In particular, but without limitation, a care management organization shall not: (1) Deny or inappropriately reduce payment to a provider of emergency health care services for any evaluation, diagnostic testing, or treatment provided to a recipient of medical assistance for a…
O.C.G.A. § 33-21A-5 Requirements relating to critical access hospitals
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(a) A critical access hospital must provide notice to a care management organization and the Department of Community Health of any alleged breaches in its contract by such care management organization. (b) If a critical access hospital satisfies the requirement of subsection (a) o…
O.C.G.A. § 33-21A-7 Bundling of provider complaints and appeals
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(a) In reviewing provider complaints or appeals related to denial of claims, a care management organization shall allow providers to consolidate complaints or appeals of multiple claims that involve the same or similar payment or coverage issues, regardless of the number of indiv…
O.C.G.A. § 33-21A-8 Participation by dentists
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(a) Except as provided in subsection (b) of this Code section, no care management organization or agent of such care management organization shall deny any dentist from participating in the Medicaid and PeachCare for Kids dental program administered by such care management organi…
O.C.G.A. § 33-21A-9 Submission and payment of claims
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(a) If a provider submits a claim to a responsible health organization for services rendered within 72 hours after the provider verifies the eligibility of the patient with that responsible health organization, the responsible health organization shall reimburse the provider in an…