[Georgia] Claims Editing Enhancements

By December 4, 2026: Billing team must implement automated claim editing compliance across billing system to address five specific rule changes: (1) Remove modifier QW from procedures not designated as CLIA waived on CareSource's clinical laboratory fee schedule; (2) Ensure E/M services billed with modifier 25 on the same day as another E/M in the same code range include clinical justification for significant and separately identifiable service; (3) Verify CPT codes 82985, 83036, 87086, and 87088 are billed only with CMS-approved diagnosis codes; (4) Limit CPT 88305 units to four or fewer unless diagnosis indicates chronic atrophic/unspecified gastritis, colorectal conditions, or prostate conditions; (5) Check five-year DME replacement history across all providers before allowing claims with modifiers RR, NU, or UE for prosthetic and orthotic devices. Non-compliant claims will be denied. Contact CareSource Provider Services at 1-855-202-1058 (Monday–Friday, 7 a.m.–7 p.m. ET) for clarification.