Georgia's Prior Authorizations

Understanding Prior Authorizations in Georgia

Prior authorizations (PAs) are a critical component of delivering Medicaid-funded home care services in Georgia. Before your agency can provide and bill for services, you need approval from the appropriate Medicaid managed care organization or fee-for-service program confirming that the services are medically necessary and authorized for a specific client.

Getting prior authorizations right is essential. Without a valid PA in place, your claims will be denied — meaning your agency does the work but doesn’t get paid.

How Prior Authorizations Work in Georgia

In Georgia’s Medicaid system, prior authorizations define what services can be provided, how many units are authorized, and the timeframe in which those services must be delivered. Here’s the general flow:

1. Referral or assessment — A case manager, physician, or care coordinator identifies the client’s need for home care services.
2. PA request submission — Your agency or the referring provider submits a prior authorization request to the appropriate payer (Georgia Families, fee-for-service, or a managed care organization).
3. Review and approval — The payer reviews the request against medical necessity criteria and either approves, modifies, or denies the authorization.
4. Service delivery — Once approved, your agency delivers services within the authorized units and timeframe.
5. Billing — Claims are submitted referencing the PA number and must match the authorized services, units, and dates.

Common Prior Authorization Pitfalls

Many Georgia home care agencies run into avoidable issues with prior authorizations. The most common problems include:

• Expired authorizations — Delivering services after the PA end date results in denied claims.
• Exceeding authorized units — Providing more units than approved without obtaining an updated PA.
• Mismatched service codes — Billing for a service code that doesn’t match what was authorized.
• Late submissions — Not requesting renewals or new PAs in time, creating gaps in coverage.
• Incomplete documentation — Missing clinical documentation to support medical necessity.

Best Practices for Managing PAs

To keep your agency’s revenue flowing and avoid denials, follow these best practices:

• Track all PA expiration dates and set reminders to begin the renewal process at least 2-3 weeks before expiration.
• Monitor unit utilization throughout the authorization period so you don’t go over or leave authorized units unused.
• Verify PA details before billing to ensure service codes, dates, and units match exactly.
• Maintain thorough clinical documentation that supports the medical necessity of every authorized service.
• Communicate with case managers early if a client’s needs change and additional services or units are required.

How GeoH Simplifies Prior Authorization Management

GeoH’s SMART Scheduling and billing tools help Georgia agencies stay on top of their prior authorizations. The platform tracks authorized units in real time, alerts you when authorizations are approaching expiration, and ensures your claims match what’s been approved — reducing denials and protecting your revenue.

Schedule a demo to see how GeoH can help your agency manage PAs more effectively.