[Georgia] March 2026 Provider Newsletter

By May 1, 2026: (1) Billing team must update claims submission processes to require full medical records for all inpatient sepsis and newborn DRG submissions effective June 1, 2026 to ensure claims accuracy and avoid denials—establish medical records attachment protocol in billing system. (2) Billing team must review and implement prior authorization requirement changes effective June 1, 2026—update encounter forms and billing software rules to reflect new authorization thresholds for affected services. (3) Billing team must implement reimbursement policy updates for bundled services/supplies and observation services facility billing effective June 1, 2026—update fee schedules and bundling rules in billing system. (4) Clinical and billing leadership must review MCG Care Guidelines 30th edition (effective June 1, 2026) for Medicare Advantage and Commercial plans and train providers on documentation requirements to support medical necessity determinations. By April 1, 2026: Billing team must ensure modifier 26 (professional services) is correctly applied to all outpatient facility UB-04 claims per updated guidance. Immediately: Billing team must verify payment indicator 2 for Assistant Surgery is reflected in current fee schedules and submit claims accordingly. Failure to comply with medical record documentation requirements and prior authorization changes will result in claim denials.