MedicaidReimbursementMedium impact
[Georgia] 2025 Obstetrics Quality Program
CareSource·GA · OB-GYN·Quality Measures
Effective date
Jan 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is launching a 2025 Obstetrics Quality Program effective January 1, 2025, that ties reimbursement to HEDIS-defined quality measures. Providers will be rewarded for quality performance in obstetric care throughout the calendar year. The billing team must review the detailed Value-Based Reimbursement flier to understand specific quality metrics and any associated documentation or coding requirements.
Action Required
By January 31, 2025: Billing and clinical teams must obtain and review the complete 2025 Obstetrics Quality Program Value-Based Reimbursement flier (referenced but not included in this notice). Identify all HEDIS quality measures applicable to obstetric services. Update encounter documentation templates and billing workflows to capture required quality measure data (e.g., screening dates, preventive care indicators). Ensure all obstetric claims include necessary supporting documentation to demonstrate quality measure compliance. Contact CareSource Provider Services at 1-855-202-1058 (Monday-Friday, 7 a.m.-7 p.m. ET) if the complete flier is not received or if clarification is needed on documentation requirements. Failure to meet quality measure documentation standards may result in reduced reimbursement or claim denials.