Georgia billing sits in the middle of a major transition. The state’s Medicaid managed care program is being restructured, with new plans entering and incumbent plans exiting, and during a transition, the fastest way to lose revenue is to bill the plan that used to hold the patient instead of the plan that holds them now.
MedPlus RCM provides medical billing, coding, credentialing, and denial management for Georgia practices of every specialty, built around the state’s actual payers and programs, including the current transition.
Georgia’s payer landscape
Georgia Medicaid is delivered through Georgia Families, a partnership between the Georgia Department of Community Health and private care management organizations (CMOs). The current Georgia Families CMOs are Amerigroup Community Care, CareSource, and Peach State Health Plan. A reprocurement has awarded new contracts, with CareSource returning and Humana, Molina, and UnitedHealthcare joining, and the transition is underway, so verifying the member’s current plan before billing matters more than ever.
Commercial coverage runs through Anthem Blue Cross Blue Shield of Georgia, UnitedHealthcare, Aetna, Cigna, and Humana, alongside Medicare and Medicare Advantage plans. Georgia Medicaid enrollment runs through the Georgia Medicaid Management Information System (GAMMIS), administered by the Department of Community Health.
What MedPlus RCM handles for Georgia practices
- End-to-end medical billing. Charge entry, claim scrubbing, submission, payment posting, and patient billing, the full cycle.
- Medical coding. Certified coders assign current ICD-10, CPT, and HCPCS codes matched to your documentation and specialty.
- Provider credentialing and enrollment. End-to-end enrollment with Georgia Families CMOs, commercial payers, and Medicare, plus re-credentialing maintenance, including re-credentialing as plans change.
- Denial management and recovery. Every denial investigated to root cause, corrected, and appealed with documentation.
- A/R recovery. Aged and outstanding balances audited and pursued, including balances already written off where the appeal window is still open.
- Financial reporting. Clean claim rates, collections, denial patterns, and A/R aging visible by payer and provider.
We serve practices statewide, Atlanta, Savannah, Augusta, Columbus, and Athens, across specialties including primary care, mental and behavioral health, cardiology, orthopedics, dermatology, and physical therapy.
Results Georgia practices can check
MedPlus RCM maintains a 99% clean claim rate and keeps client accounts receivable under 30 days. Pricing is a performance-based percentage of successfully collected revenue: if you don’t get paid, we don’t get paid. We are 100% HIPAA compliant, and onboarding takes 2 to 4 weeks depending on practice size, with no disruption to your daily cash flow.
Frequently asked questions
What is Georgia Families?
Georgia Families is Georgia’s Medicaid managed care program, delivered through care management organizations (CMOs). Members choose a CMO plan, and practices bill that plan for covered services.
Which Georgia Medicaid CMOs do you work with?
We work with the current Georgia Families CMOs, Amerigroup Community Care, CareSource, and Peach State Health Plan, and track the transition to the newly awarded plans (CareSource, Humana, Molina, and UnitedHealthcare) so claims route to the plan that currently holds the member.
How long does it take to switch our billing to MedPlus RCM?
Onboarding takes between 2 and 4 weeks depending on practice size, including data migration and payer clearinghouse setup.
What does MedPlus RCM charge?
A performance-based percentage of successfully collected revenue. If you don’t get paid, we don’t get paid.
Get a free financial audit
Find out where your Georgia practice is losing revenue. Request a free financial audit and our specialists will review your claims, denials, and A/R.
