Bill > SB276

This bill amends Georgia law to update regulations governing how third-party payers (such as insurance companies, health plans, and pharmacy benefit managers) must interact with the Department of Community Health when processing medical assistance claims. The key changes include requiring third-party payers to respond to department inquiries about healthcare claims within 60 days, prohibiting them from refusing payment solely because a healthcare item or service did not receive prior authorization, and maintaining existing requirements for cooperating with the department's medical assistance recovery efforts. The bill also preserves the requirement for these entities to provide eligibility and claims payment data quarterly, accept payment assignments, and not deny claims based on submission technicalities, as long as claims are submitted within three years of service and any enforcement actions begin within six years of claim submission. These modifications aim to streamline the medical assistance claims process and ensure more efficient cooperation between healthcare providers, insurance companies, and the state's medical assistance program.

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https://www.legis.ga.gov/legislation/70919