[Georgia] Expanding Site of Care Program for musculoskeletal and surgical procedures

By March 15, 2026: Billing and clinical teams must implement the following changes: (1) Update billing software to require prior authorization/precertification for ALL musculoskeletal and surgical procedures scheduled at outpatient hospital settings; (2) Modify encounter forms and scheduling workflows to identify the intended site of care (ASC, outpatient facility, or hospital outpatient); (3) Train billing staff to submit precertification requests through Availity for hospital outpatient procedures before scheduling; (4) Establish communication protocol with providers to discuss site-of-care expectations for MSK and surgical cases; (5) Create internal documentation to track which procedures are being redirected to ASCs vs. hospital outpatient settings. Failure to obtain precertification for hospital outpatient procedures will likely result in claim denials or payment delays. Contact Anthem via Availity Chat (https://Availity.com) with any questions about specific procedure classifications or precertification requirements.