Medicaid

Since 1972, GMCF has been providing medical peer review and consultative services, utilization and quality management review services for Medicaid Programs. GMCF utilizes a professional multi-disciplinary work team to perform utilization management activities, which include reviews for: precertification for inpatient admissions and outpatient procedures, durable medical equipment (DME), orthotics and prosthetics (O&P), vision care, dental care, additional physician office visits, additional psychiatric and psychological services, in-state transplants, out-of-state services, oral maxillofacial surgery, medication administration, imaging procedures, Preadmission Screening/Resident Review (PASRR), and Swingbed reviews.

GMCF performs level-of-care determination and oversight functions for waiver programs including: Katie Beckett, Georgia Pediatric Program/Exceptional Children’s Services, Children Intervention Services, Children’s Intervention School Services, and the Independent Care Waiver Program.

In addition, GMCF conducts medical review of suspended claims, peer review activities, and the SURS reviews. GMCF maintains a physician consultant roster of more than 300 actively practicing Georgia physicians who represent 50 medical specialties, and who are utilized to support medical peer review and utilization management functions. GMCF provides an oversight role for the Georgia Nurse Aide Program and maintains a medical agency and referral network for Medicaid members and providers

Georgia Health Partnership Web Portal
Use the above site to access more information regarding the Georgia Health Partnership.