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Medicaid: Termination of Providers

The Affordable Care Act mandates that states revalidate the enrollment of all providers every five (5) years. Beginning in April 2014 and monthly thereafter, DCH and Hewlett-Packard Enterprise Services (HPES) sent letters to providers requiring that they revalidate their enrollment within 60 days of the date on the letter. A significant number of the letters mailed to providers noted above were returned to HP Enterprise Services. It is critical that providers ensure that their mail-to-address is correct in the Georgia Medicaid Management Information System (GAMMIS). Providers can review or update their mail-to address information by logging into GAMMIS and clicking on Demographic Maintenance.

On April 1, 2015, DCH suspended those providers who had a deadline to revalidate their enrollment from June 1, 2014 through October 1, 2014 and failed to comply. Notices were sent to those providers that were suspended. On June 1, 2015, DCH will terminate those providers who were suspended on April 1, 2015, that have not submitted a Revalidation enrollment application by May 30, 2015. Providers will be terminated from Traditional Fee-for-Service Medicaid and PeachCare for Kids, Georgia Families, and Georgia Families 360 managed care programs which are currently administered by WellCare, Peach State Health Plan, and Amerigroup. Claims for services rendered to members enrolled in Traditional Fee-for-Service Medicaid and PeachCare for Kids, Georgia Families, and Georgia Families 360 managed care programs for dates of service on or after April 1, 2015, will not be paid.

A report of those providers who have not revalidated through October 1, 2014, can be found online through the GAMMIS at Georgia Department of Community Health. Click on the Provider Information/Provider Notices tabs. Providers who are on this report who have not submitted a Revalidation application by May 30, 2015, will be terminated on June 1, 2015. Providers who were suspended and have submitted a Revalidation application will not be affected.

Providers who are terminated will be required to re-enroll in Traditional Fee-for-Service Medicaid and PeachCare for Kids, the Georgia Families, and Georgia Families 360 managed care programs. Providers who are terminated and wish to participate in the managed care network(s) will be required to execute a new contract with the managed care entities.

A Frequently Asked Questions (FAQ) regarding revalidation can be found on GAMMIS at Georgia Department of Community Health. Click on Provider Information/FAQ for Providers. In addition, providers may contact Medicaid's fiscal agent HPES at 800-766-4456 (Option #1) or e-mail DCH at revalidationenrollment2@dch.ga.gov for assistance.

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Last Updated On: 4/21/2021