Georgia Medicaid Prepayment Review Status

Georgia Medicaid Prepayment Review Status
Providers cannot appeal pre-payment review status, but can appeal denials of claims.  The appeal must be submitted within 30 days of the denial of the claim.  When a provider is on pre-payment review status, claims will only be paid if they comply with Georgia Medicaid guidelines; if the claim does not comply with Medicaid guidelines, it will be denied and the reason for the denial will be stated.  A provider can resubmit a claim that is initially denied, but the claim will only be paid if the error is corrected.  According to Victoria, all of this information is contained within the notice of pre-payment suspension that was sent to you.
Therefore, filing an appeal will not automatically result in payment of the denied claims; there will be a hearing on whether the claims were properly denied.  If a claim was denied over 30 days ago, any relief that you obtain might have to come from an appellate court, which appears to be the Georgia superior courts.
Because there is no guarantee that we will be permitted to participate in an administrative hearing or a Georgia Superior Court proceeding, we recommend that you retain local counsel to preserve your resources on counsel that doesn’t carry the risk that comes from being licensed out of state.
Georgia Medicaid Prepayment Review Status