Changes to Georgia Medicaid MCOs: What It Means for ABA Providers

Georgia’s Medicaid program continues to evolve, and ABA providers need to stay in the loop, especially when it comes to how services are managed through Managed Care Organizations (MCOs).

As of March 2025, Georgia has updated its Medicaid MCO contracts under the Georgia Families and Georgia Families 360° programs. The state currently works with the following MCOs:

• Amerigroup Community Care

• CareSource Georgia

• Peach State Health Plan

These MCOs are responsible for managing Medicaid benefits (including ABA therapy) for thousands of families across the state. So, any change in their policies, processes, or network access directly affects your ability to provide care and get paid for it.

Why This Matters for ABA Providers

While the Medicaid rate increases and code updates announced in 2024 were a big step forward, the implementation of these changes is where many providers are feeling the pressure. Here’s how:

1. Credentialing & Network Access Delays

With the new rules and guidelines in place, some MCOs have temporarily paused onboarding new ABA providers. They’re adjusting internal systems, reworking authorization protocols, and training staff, all of which takes time.

This has created bottlenecks in:

• Getting credentialed as a new provider

• Updating existing contracts

• Expanding to new service areas (like rural counties or growing suburbs)

If you're trying to get in-network with Medicaid clients through these MCOs, be prepared for longer processing times or temporary freezes on new applications.

2. Authorization and Billing Policy Adjustments

Each MCO may interpret and roll out Medicaid changes a bit differently.

For example:

• Code unbundling (97153, 97155, 97157, etc.) now requires more detailed service descriptions and individual pre-authorizations.

• Supervision rules have shifted, and certain types of oversight are no longer billable under the same codes

• Rate changes haven’t always been reflected in provider portals or claims processing systems yet

As an ABA provider, you may notice more documentation requests, slower approvals, or claim denials, even for services you’ve routinely billed in the past.

3. Emphasis on Outcomes & Data

MCOs are beginning to align with Medicaid’s push toward data-driven treatment. This means you may start seeing:

• Requests for clinical outcome data tied to authorizations

• Stricter documentation audits

• Greater focus on individualized care plans

This is a great opportunity to showcase the value of your services—but it also means your documentation processes need to be airtight.

What You Can Do

If you’re an ABA provider in Georgia working with, or trying to join, one of the state’s MCOs, here are some practical steps you can take:

• Follow up regularly on credentialing or contract applications

• Review all MCO-specific billing policies (they’re not always the same)

• Audit your claims for denials or underpayments—especially around the rate changes

• Train your clinical team on documentation requirements that support billing and authorizations

• Track all communication with MCO reps, especially around onboarding timelines

Need Help Navigating the Changes?

At Essential Billing Solutions, we’re partnering with ABA clinics across Georgia to simplify MCO claims management and support providers through every step of the Medicaid process. Our goal is to handle the billing complexities, so you can stay focused on delivering quality care.

Feeling overwhelmed by MCO claims? We’re here to help make sense of it all!

Schedule Your FREE Consultation!