Credentialing in Georgia

Georgia Medicaid spans fee-for-service, PeachCare, and the Georgia Families / Georgia Families 360 managed-care programs, whose plans are Amerigroup, CareSource, and Peach State. Statewide enrollment actions such as the July 2026 revalidation suspension apply across FFS, PeachCare, and all Georgia Families plans.

GA DCH announcement 'Provider Revalidation Deadline - July 1, 2026' via kb/states/ga.md · checked Jul 2026

Georgia Medicaid revalidates every enrolled provider on a 5-year cycle, GA DCH: 'Federal regulations require State Medicaid Agencies to revalidate the enrollment of all providers, regardless of provider type, at least every five years (42 CFR 455.414).' Missing revalidation means suspension, and claims with dates of service on or after the deadline are denied.

GA DCH announcement 'Provider Revalidation Deadline - July 1, 2026' via kb/states/ga.md · checked Jul 2026

If a Georgia provider is suspended for missed revalidation and later cures it, the new effective date is the date the revalidation application is submitted. GA DCH: 'your effective date will be the date that you submit your revalidation application. Retro-enrollment is NOT applicable in this instance.' The gap between suspension and re-submission is a permanent unbillable hole.

GA DCH announcement 'Provider Revalidation Deadline - July 1, 2026' via kb/states/ga.md · checked Jul 2026

Georgia associates (APC/LAPC, LAMFT, LMSW) render Medicaid community behavioral-health services inside DBHDD-network provider agencies as Practitioner Level 4 staff, with 'associate-level clinicians.. under supervision in accordance with O.C.G.A. § 43-10A-11.' The agency bills with practitioner-level modifiers (U4 = Level 4, e.g. psychotherapy 90834 U4) at Level-4 rates, a discount below the Level-3 rates paid for full licensees (LCSW/LPC/LMFT). The Level-4 tier even covers a supervisee/trainee with only a bachelor's degree in a helping profession; the money and the enrollment stay with the agency.

GA DBHDD Provider Manual FY 2027 Q1 via kb/states/ga.md · checked Jul 2026

Effective July 1, 2026, GA DCH suspends the enrollment of providers who failed to revalidate, 'Claims with dates of service on or after July 1, 2026, will not be paid.' The past-due list is posted on GAMMIS under Provider Information, Reports for Public Access, 'Provider Revalidation Past Due by Provider Type,' and the suspension applies to fee-for-service, PeachCare, and Georgia Families / GF 360.

GA DCH announcement 'Provider Revalidation Deadline - July 1, 2026' via kb/states/ga.md · checked Jul 2026

GA SPA 25-0007 (approved 2025-09-30, effective 2025-07-01) added the Therapeutic Care Model (TCM) to Georgia's state plan as a rehabilitative service under 42 CFR 440.130, listing LMSW, LAPC, and LAMFT among its qualified practitioners. Even at the state-plan level, associates appear only inside an agency-delivered service model, never as independent enrollees.

GA SPA 25-0007 approval package (medicaid.gov) via kb/states/ga.md · checked Jul 2026