Medicare AdvantageDocumentationHigh impact
[Georgia] Evaluation and Management Coding Review
CareSource·GA·Coding
Effective date
Jun 29, 2026
We identified it
May 9, 2026
Summary
CareSource will implement a level of care review program for all E&M coding levels effective June 29, 2026. Certified nurse review coders will randomly audit claims to ensure documentation supports the billed coding level; claims not supported by documentation will be downgraded to the appropriate level. Providers can dispute determinations through the standard claims dispute process.
Action Required
By June 29, 2026: Billing team and providers must ensure all E&M encounters are documented with complete medical records including pertinent health and social history, physical exam findings, test results, assessment, and care plan that support the billed E&M level. Audit E&M coding practices in billing system and EMR templates to confirm documentation standards are met. Implement internal compliance review process for E&M claims before submission. Train billing staff and providers on documentation requirements to support appropriate coding levels. Establish process for tracking and responding to CareSource claim determinations and filing disputes within 30 days with supporting clinical documentation. Failure to maintain adequate documentation will result in claims being paid at a lower supported level, reducing revenue.