Georgia gives behavioral health practices a 15-working-day prompt pay clock, one Blue plan for the whole state, and a Medicaid program in the middle of changing health plans. Knowing which of those rules applies to each claim is what keeps a Georgia practice’s cash flow steady. Maximum Billing provides behavioral health and psychiatric billing for Georgia counselors, therapists, social workers, and group practices, from metro Atlanta to Savannah, Augusta, Macon, and Columbus.
Georgia is among the twelve states our team bills in. Request a consultation or call 800-820-0364.
Georgia at a Glance for Behavioral Health Billing
- Payers must move quickly. Georgia law gives insurers 15 working days to pay or deny a complete electronic claim.
- Anthem is the only Blue plan. Anthem Blue Cross and Blue Shield covers the entire state, alongside Aetna, Cigna, UnitedHealthcare, Kaiser Permanente in metro Atlanta, and Ambetter from Peach State Health Plan on the individual market.
- Medicaid is mostly managed care, with exceptions. Most members are in a Georgia Families care management organization, while many aged, blind, and disabled members remain in fee-for-service.
- Associate clinicians hold their own licenses. APCs, LMSWs, and associate marriage and family therapists are licensed by the state while they work toward independent licensure.
- A large military population. Georgia’s Army, Air Force, and Navy installations make TRICARE a real part of many practices’ payer mix.
Georgia’s Prompt Pay Law
Under O.C.G.A. Section 33-24-59.14, insurers and plan administrators must pay a claim, or send a letter explaining a denial, within 15 working days of receiving a complete electronic claim, or within 30 calendar days for a paper claim. If they need more documentation, they must ask for it in writing, and the clock restarts once it arrives. When a payer misses the deadline, it owes interest of 12 percent per year on the benefits due. Undisputed portions of a claim still have to be paid on time. Because the window is so short, we file clean electronic claims and follow up as soon as the deadline passes, not weeks later. Employer plans that self-insure under ERISA are generally governed by federal law instead.
Georgia Medicaid and the CMO Transition
Georgia Medicaid and PeachCare for Kids, the state’s CHIP program, cover most members through Georgia Families, a managed care program run by care management organizations. Today those CMOs are Amerigroup, CareSource, and Peach State Health Plan. Children in foster care and adoption assistance are covered through Georgia Families 360°. Many members who are aged, blind, or disabled, and most who also have Medicare, stay in fee-for-service Medicaid and are billed to the state directly.
That structure is changing. In December 2024 the state announced CareSource, Humana, Molina, and UnitedHealthcare as the apparent winners of a new Georgia Families contract, with UnitedHealthcare designated for Georgia Families 360°. As of spring 2026, the procurement was still in the protest phase awaiting a formal notice of award, and the Department of Community Health had extended the current CMO contracts through June 30, 2027. When the transition happens, practices will need new contracts and credentialing with any new plan their clients move to, and authorizations and claims will have to follow each client to the right plan. We watch those dates for our clients so enrollment is ready before members move.
Medicaid Enrollment Through GAMMIS
Every clinician who treats Georgia Medicaid members must be enrolled with the state through GAMMIS, the Georgia Medicaid Management Information System, whether the client is in fee-for-service or a CMO. CMO members then require separate credentialing and, for many services, prior authorization with that specific plan. We handle GAMMIS enrollment and revalidation along with each CMO application.
Georgia Pathways to Coverage
Georgia did not adopt full Medicaid expansion. Instead, Georgia Pathways to Coverage offers Medicaid to some lower-income adults who meet a monthly requirement of 80 hours of work or other qualifying activities. Rules eased in October 2025, so members now report their activities at application and renewal rather than every month. The program is approved through December 31, 2026. For a practice, a Pathways client’s coverage can depend on renewal and reporting, so we verify eligibility before sessions rather than assuming it carried over.
Commercial Plans and the State Health Benefit Plan
With Anthem as the single Blue plan, a Georgia practice does not have to sort out regional Blues. The work is in the plan details: Anthem, Aetna, Cigna, and UnitedHealthcare each offer HMO, PPO, and narrow-network products, and several route behavioral health through a separate administrator. Kaiser Permanente operates an HMO in metro Atlanta, and individual-market plans are sold through Georgia Access, the state-based exchange that replaced HealthCare.gov for the 2025 plan year.
State employees, teachers, and other school system staff are covered through the State Health Benefit Plan, which offers options through Anthem, UnitedHealthcare, and Kaiser Permanente. The carrier on the member’s card determines where their claims go. Our insurance verification services confirm the exact plan and its behavioral health rules before the first visit.
The Georgia Telehealth Act
Georgia’s Telehealth Act, O.C.G.A. Section 33-24-56.4, requires insurers to cover services provided through telehealth and bars them from excluding a service only because it was delivered remotely. Insurers must reimburse telemedicine on the same basis, and at least at the rate, as the same service delivered in person. The act specifically does not require insurers to pay for audio-only calls for services other than mental or behavioral health, so behavioral health is the one area where that audio-only carve-out does not apply. Payers still set their own place of service and modifier rules, so we code every telehealth session to the payer’s current policy. Clients who are physically in Alabama, Florida, South Carolina, North Carolina, or Tennessee during a session need a license check before it is billed.
Associate Licenses and Supervised Clinicians
Georgia’s Composite Board of Professional Counselors, Social Workers, and Marriage and Family Therapists licenses clinicians on a two-tier ladder: Associate Professional Counselors become LPCs, Licensed Master Social Workers become LCSWs, and associate marriage and family therapists become LMFTs. Associates practice under clinical direction and supervision. Having a Georgia license number helps, but it does not guarantee payment. Some payers credential associates, others will only pay for the supervising clinician, and many do not reimburse associate services at all. We check each payer’s policy before an associate’s sessions are billed.
Medicare and TRICARE in Georgia
Palmetto GBA processes Georgia Medicare claims as the Medicare Administrative Contractor for Jurisdiction J, which also covers Alabama and Tennessee. Since January 1, 2024, LPCs and LMFTs can enroll in Medicare as mental health counselors and marriage and family therapists. Georgia is also home to Fort Benning, Fort Stewart, Fort Gordon, Robins and Moody Air Force Bases, and Naval Submarine Base Kings Bay, so practices in Columbus, Hinesville, Savannah, Augusta, Warner Robins, Valdosta, and St. Marys often see many TRICARE East members.
Credentialing a Georgia Practice
A typical Georgia group may need GAMMIS enrollment, contracts with each Georgia Families CMO, Anthem, Aetna, Cigna, UnitedHealthcare, Kaiser for Atlanta clients, TRICARE, and Medicare, for every clinician, plus a plan for the new CMOs. Until each network’s effective date, sessions are typically paid out of network or not at all. We complete applications, maintain CAQH, and follow each one to approval. See our behavioral health credentialing service for details. For the Medicaid side, see our Georgia Medicaid provider enrollment guide.
Where Georgia Claims Go Wrong
- A Medicaid claim went to the wrong CMO. The client changed plans, or is in Georgia Families 360° rather than a standard CMO.
- The clinician is missing GAMMIS enrollment. CMO credentialing does not replace it.
- No prior authorization. Many CMO behavioral health services require one.
- Pathways coverage lapsed. The client did not complete renewal or reporting.
- An associate’s session was billed to a payer that does not recognize associates.
- A late follow-up. With a 15-working-day clock, a claim left alone for a month may already be accruing interest.
For backlogs and repeated denials, our claims denial management service works each claim to resolution.
Georgia Regions We Serve
Metro Atlanta practices see the widest mix: Anthem, Aetna, Cigna, UnitedHealthcare, Kaiser, marketplace plans, and every CMO. Savannah and the coast add heavy TRICARE volume from Fort Stewart, Hunter Army Airfield, and Kings Bay. Augusta practices bill TRICARE for Fort Gordon families alongside Anthem and the CMOs. Columbus, Macon, and Warner Robins combine military, State Health Benefit Plan, and Medicaid clients, and South Georgia practices near Valdosta and Albany often carry a larger share of Medicaid and Pathways members. We set up billing for the mix your area actually has.
What Our Georgia Behavioral Health Billing Includes
- Eligibility and benefits checks for commercial, State Health Benefit Plan, CMO, fee-for-service Medicaid, Pathways, PeachCare, TRICARE, and Medicare clients.
- Coding and claim submission for evaluations, psychotherapy, family and group sessions, and psychiatric visits.
- Telehealth and audio-only claims coded to each payer’s policy.
- Prior authorization tracking for CMO services.
- Prompt follow-up at the 15-working-day mark, plus appeals and corrected claims.
- GAMMIS enrollment, CMO credentialing, and preparation for the Georgia Families transition.
Group practices can also read about our therapy billing services. We have behavioral health pages for New Jersey, New York, Pennsylvania, North Carolina, Illinois, Colorado, South Carolina, Connecticut, Missouri, Florida, and Texas as well.
Frequently Asked Questions
Will the new Georgia Families CMOs affect our practice?
If you see Medicaid or PeachCare clients, probably. Any client moved to a plan you are not contracted with could become out of network, so we start credentialing with incoming plans ahead of the switch.
Can you bill for APCs, LMSWs, and associate MFTs?
Yes, with payers that recognize associate licenses. We confirm each payer’s supervision and billing rules first.
Do Georgia payers really have to pay in 15 working days?
For complete electronic claims under insurance plans subject to Georgia law, yes, or they owe 12 percent annual interest. Self-funded ERISA plans generally follow federal rules.
Which software do you use?
We work in the systems practices already have, including SimplePractice, TherapyNotes, Sessions Health, and InSync.
Start Billing Georgia Claims With Us
Whether you are preparing for the CMO change, adding associate clinicians, or simply tired of chasing Anthem claims, our team can help. Contact us or call 800-820-0364 to talk through your Georgia practice.