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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.

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