MedicaidDocumentationMedium impact
[Georgia] Revised Process for Clinical Practice Guideline (CPG) Audits
CareSource·GA · Psychiatry, Endocrinology, OB-GYN +2 more·Medical Policy
Effective date
Aug 29, 2025
We identified it
May 9, 2026
Summary
Georgia Medicaid (CareSource) has revised its Clinical Practice Guideline (CPG) audit process for medical records. Hypertension audits are discontinued; audits now focus on depression, diabetes, and perinatal care. Providers selected for audit will be reviewed on only one diagnosis per year. Providers failing the same quality indicator(s) in three or more records will receive a reaudit after a minimum of 90 days.
Action Required
By September 29, 2025: Billing and clinical teams must familiarize themselves with the revised CPG audit process. (1) Providers should review the Clinical Practice Guidelines Medical Record Audit Provider Brochure from CareSource to understand quality indicators for depression, diabetes, and perinatal care. (2) Ensure medical record documentation templates and EMR systems include required quality indicators for these three diagnosis areas. (3) Clinical staff must verify that clinical documentation for these conditions meets DCH standards. (4) Notify all clinical providers that hypertension CPG audits have been discontinued and should no longer prepare for those audits. (5) Maintain awareness that if selected, the practice will be audited on only ONE of the three diagnoses for the calendar year. Failure to maintain compliant documentation may result in reaudits after 90 days and potential compliance actions by CareSource.