Georgia Medicaid Claims Processor Gets Cutting Edge

ATLANTA–After a year of waiting for the state’s Medicaid
contractor to launch a state-of-the-art Web portal, providers now
have a cutting-edge system that sources say is a model of efficient
claims processing.

According to Jason Rogers, vice president of Care Medical in
Athens, Ga., the new Web portal, developed by Dallas-based
Affiliated Computer Systems, gives providers “an immediate response
as to whether a claim is paid or denied” for certain claims. The
system immediately catches common errors–such as incorrect birth
dates or change-of-service information–that would otherwise cause
lengthy payment delays, he said. The system also allows providers
to submit prior authorization applications online, streamlining a
process that has traditionally “been a mess with Medicaid in
Georgia,” Rogers added.

The solution was a long time coming. On April 1, 2004, ACS
launched its Web portal, but “it just didn’t work,” Rogers said.
“The links didn’t function.” Yet by earlier this year, the company
finally finished de-bugging the system.

Rogers concluded, “It took a year, but, now that it’s over,
we’re in a very good place.”

The situation stands in sharp contrast to that in 2003 when ACS
first took over claims processing for the state. Massive
difficulties ensued over HIPAA-compliant electronic claims
processing, resulting in long payment delays. Today, Rogers said
the problem has, by and large, been solved.

For more information on the system, visit Georgia’s Medicaid Web
portal at www.ghp.georgia.gov.