Appendix C: Medicaid Issuance | Medicaid
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Georgia Division of Family and Children Services |
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Policy Title: |
Medicaid Issuance |
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Effective Date: |
May 2026 |
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Chapter: |
Appendix C |
Policy Number: |
Appendix C |
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Previous MT Number(s): |
MT 67 |
Updated or Reviewed in MT: |
MT 79 |
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Requirements
Medicaid cards are issued to individuals eligible for Medicaid only benefits. Recipients present the cards to Medicaid providers to verify Medicaid eligibility.
Medicaid providers should confirm Medicaid eligibility at each visit via the Interactive Voice Response system (IVR) or GAMMIS web portal.
Basic Considerations
Medicaid eligibility determined by DFCS, is transmitted to the Department of Community Health (DCH) through interfaces.
GAMMIS
Medicaid eligibility in DCH’s computer system, Georgia Medicaid Management Information System (GAMMIS), may be viewed at mmis.georgia.gov by the member and DFCS staff.
Members
The Gainwell Technologies Member Contact Center is available by phone at 770-325-2331 local or toll-free outside the metro area at 1-866-211-0950. Members may also confirm eligibility in GAMMIS by calling the Gainwell Technologies Member Contact Center and accessing the Interactive Voice Response system (IVR) at 1-866-211-0950.
Providers
The Gainwell Technologies Provider Contact Center is available by phone at 770-325-9600 local or toll free outside the metro area at 1-800-766-4456. Providers may call the Gainwell Technologies Provider Contact Center to access the IVR at 1-800-766-4456. The IVR is operational 24 hours a day, seven days a week. Callers who prefer speaking with a person may opt out of the IVR once it is accessed.
Providers may verify pharmacy eligibility by calling Optum Rx at 1-866-525-5827. For clinical-prior authorization support, call 1-800-766-4456.
| Members eligible for SLMB, QI-1 or QDWI will be shown as ineligible on the web portal and IVR. |
Medicaid Cards
Upon approval of a Medicaid application, DCH will issue each Medicaid eligible member a Medicaid card to be used when the member wishes to obtain Medicaid services. The member’s eligibility and any limitations associated with a particular Class of Assistance (COA) under which eligibility is determined is reflected in the IVR and the GAMMIS web portal.
Card Issuance
Certain Medicaid recipients who are approved in the following circumstances are not issued a Medicaid card:
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Eligibility determined under SLMB, QI-1, and QDWI COAs
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EMA under any COA
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Retroactive eligibility under any COA
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Hospice if no “Lock In” is received from the Hospice provider
Medicaid recipients are not reissued a Medicaid card in the following circumstances:
DCH performs nightly card runs to issue cards to newly eligible members and to members who have reported lost or undelivered cards. Members enrolled in a CMO will have their Medicaid card mailed from the assigned CMO only. Recipients should expect the Medicaid card within a reasonable timeframe from date of Medicaid approval or request for replacement card. (Refer to Card Issuance above.)
Delivery of Cards
Medicaid cards are mailed to the residential or mailing address provided to DCH by SSA or DFCS through computer system interfaces.
Medicaid cards that cannot be delivered to the HOH are returned to the sender. Members who need a replacement card should request the Member Contact Center update their address and reissue the card. If the member is enrolled in a CMO, they should contact their CMO for a replacement card. The member should also notify DFCS of any change in address to be changed in Gateway. Gateway data is the source data and will override what is manually changed in GAMMIS. DCH is responsible for verifying Medicaid eligibility for all Georgia Medicaid members for Medicaid providers.
Medicaid Identification Numbers
A 9-digit Client ID number is assigned by Gateway and transmitted to DCH via the interface. GAMMIS then assigns a 12-digit Medicaid number. Medicaid numbers issued prior to 11/01/2010 will begin with '111', numbers issued after 11/01/2010 will begin with '222'. A Medicaid provider should be able to file Medicaid claims by using DCH’s 12-digit number. SSI recipients may use their 9-digit Social Security Number plus an “S” (i.e.,123456789S) or the 12-digit Medicaid number.
Other Medicaid Eligibility Forms
Other Medicaid eligibility forms are issued in the following situations:
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Form DMA 634 – Approval/Denial Notice of Action is issued to the member by the Georgia Department of Public Health and certain Qualified Providers when a Presumptive Pregnant Women application is completed. A copy is forwarded to DFCS along with Form DMA 632 – PE PGW Application. The presumptive Medicaid number is used by the member until such time a plastic Medicaid card is mailed. Refer to Section 2067 – Presumptive Medicaid.
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Form DMA 634H - Notice of Action Approval/Denial is issued to the member by the Georgia Department of Public Health and certain Qualified Hospitals when a Hospital Presumptive Medical Assistance application is completed. A copy is forwarded to DFCS along with Form DMA 632H – PE Hospital Application. The presumptive Medicaid number is used by the member until such time a plastic Medicaid card is mailed. Refer to Section 2067 – Presumptive Medicaid.
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Form DMA 634W – Approval/Denial Notice of Action is issued to the member by the Georgia Department of Public Health and its designated partner providers when a Women’s Health Medicaid application is completed. A copy is forwarded to DFCS along with Form DMA 632W – PE WHM Application This certification form entitles women who have been diagnosed with breast or cervical cancer to all covered Medicaid services. Refer to Section 2198 – Women’s Health Medicaid.
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SSI Pregnant Woman Update form is completed for presumptive applications when the applicant is active on SSI. Georgia Department of Public Health (DPH) should complete and securely email to DCH at pecorrections@dch.ga.gov. If a pregnant SSI recipient contacts a county DFCS office with co-payment concerns, the DFCS caseworker should complete the SSI Pregnant Woman Update form and securely email to pecorrections@dch.ga.gov.
Procedures
Completing Form 962
Form 962 - Certification of Medicaid Eligibility is completed when:
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medical services are needed prior to the time a Medicaid card is issued by DCH
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eligibility cannot be entered in Gateway (Refer to Chart C.1)
Form 962 should never be issued:
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for QMB, SLMB, QI-1, or QDWI recipients
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to recipients or providers such as nursing homes, cost recovery agencies, etc.
The DFCS caseworker:
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uploads a copy of Form 962 to GAMMIS Web Portal at mmis.georgia.gov
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documents the case in Gateway providing reason for use of 962
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uploads a copy of Form 962 to the Gateway case record
The Form 962 with revision date 09/2024 or later should be used for both current and historical months. Refer to the Medical Assistance SharePoint for the most current version of Form 962.
Changes and Corrections for SSI Clients
Existing and ongoing SSI clients should report changes and corrections to the Social Security Administration.
Prior Approval and Emergency Doctor’s Visits
For out-of-state providers rendering emergency services, providers follow Policies and Procedures for Hospital Services, Section 909 as found on the GAMMIS web portal, Provider’s Manuals.
Out-of-State Providers and Service Limitations: Out-of-State hospital providers that are not enrolled in the Georgia Medicaid program as participating providers will be reimbursed for covered services provided to eligible Georgia members while out-of-state if the following conditions are met:
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The service was provided as a result of an emergency or life-endangering situation occurring out-of-state. (If the out-of-state provider believes the medical record supports the existence of an emergency situation but the diagnosis does not justify an emergency, the claim must be submitted with a copy of the medical record.) OR
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the claim is received within twelve months from the month of services AND
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Prior Authorization for the service was obtain from the Department of Community Health
Providers can obtain more information regarding filing claims, or other questions at mmis.georgia.gov.
For physicians to have procedures prior approved, they should submit the Prior Authorization via the GAMMIS web portal.
Georgia Families
Georgia Families is a partnership between the Department of Community Health (DCH) and Care Management Organizations (CMOs) to expand managed care in Georgia and promote increased access to and utilization of primary and preventative care. The Department of Community Health has contracted with three CMOs to provide these services throughout the state. They are:
| CMO | Phone Number | Website |
|---|---|---|
Amerigroup |
800-600-4441 |
amerigroup.com/medicaid |
CareSource |
855-202-0729 |
caresource.com |
Peach State Health Plan |
800-704-1484 |
pshpgeorgia.com |
Members can contact Georgia Families for assistance to determine which program best fits their family’s needs. If members do not select a plan, Georgia Families will select a health plan for them.
Members can visit the Georgia Families Website at www.georgia-families.com or call 1-800-GA-ENROLL (1-888-423-6765) to speak to a representative who can give them information about the CMOs and the health care providers.
Children, pregnant women and women with breast or cervical cancer who receive Medicaid, as well as children enrolled in PeachCare for Kids® are eligible to participate in Georgia Families.
Enrollment in a (CMO) is a requirement for recipients in the following programs:
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Parent/Caretaker with Children Medicaid
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Pregnant Women Medicaid
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Children Under 19 Medicaid
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PeachCare for Kids®
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Women’s Health Medicaid
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Transitional Medical Assistance
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Planning for Healthy Babies
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Pathways
The following recipients are not required to enroll in a CMO:
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People who need special medical services or live in an institution
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People who receive Medicaid and qualify for Medicare
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People who receive Medicaid that are government approved as part of an Indian tribe
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People who qualify for Supplemental Security Income (SSI)
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Children who are in the Children’s Medical Services Program
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Children who are in the Georgia Pediatric Program
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Children with care coordination by the Multi-Agency Team for Children (MATCH) program
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People who reside in Long Term Care
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People who receive services through the Service Options Using Resources in Community Environments (SOURCE) program
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People in Pre-Admission Screening and Resident Review
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People who receive Hospice Care
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People who receive Health Insurance Premium Payments (HIPP)
CMO Issues
CMO issues that an A/R is unable to resolve by contacting the individual CMO should be sent to mgdc.complaints@dch.ga.gov for resolution.
Issuance of Form 962, Certification of Medicaid Eligibility Chart
Use the following chart to determine when Medicaid cards will be issued by DCH/and when DFCS should issue Medicaid authorization forms. Refer to Complete Form 962 section above.
| Form 962 should NEVER be given to members, providers, Nursing Homes, Cost Recovery agency, etc. |
| CIRCUMSTANCE | URGENCY | REQUIRED FORMS | PRESCRIPTIONS | GAINWELL CONTACT CENTER |
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A newly eligible SSI recipient requires medical services prior to receiving his or her first Medicaid card from DCH |
Non-emergency |
Advise the recipient to obtain a “Certification for SSI Eligibility Form” from SSA Upload a copy of the Certification for SSI Eligibility Letter to GAMMIS Web Portal at mmis.georgia.gov |
OptumRX will be updated via the GAMMIS interface regarding prescriptions. |
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A newly eligible SSI recipient requires medical services prior to receiving his or her first Medicaid card from DCH |
Emergency |
Advise the recipient to obtain a “Certification for SSI Eligibility Form” from SSA Upload a copy of the Certification for SSI Eligibility Letter to GAMMIS Web Portal at mmis.georgia.gov |
If recipient needs emergency prescriptions, County designee should upload Form 962 to GAMMIS Web Portal at mmis.georgia.gov and include a note that recipient has an emergency. |
After uploading Form 962, County designee can call the Member Contact Center to confirm receipt of 962 and request GAMMIS update using the dedicated DFCS line 1- 877-512-3130. |
A newly eligible SSI recipient requires medical services prior to receiving his or her first Medicaid card from DCH |
Life Threatening |
Advise the recipient to obtain a “Certification for SSI Eligibility Form” from SSA Upload a copy of the Certification for SSI Eligibility Letter to GAMMIS Web Portal at mmis.georgia.gov |
If recipient needs emergency prescriptions, County designee should upload Form 962 to GAMMIS Web Portal at mmis.georgia.gov and include a note that recipient has a life-threatening emergency. |
After uploading Form 962, County designee can call the Member Contact Center to confirm receipt of 962 and request GAMMIS update using the dedicated DFCS line 1- 877-512-3130. |
An SSI recipient from another state moves to Georgia AND continues to be eligible for Medicaid through SSI in Georgia AND Needs medical services the month of move |
All |
Advise the recipient to obtain a “Certification for SSI Eligibility Form” from SSA Upload a copy of the Certification for SSI Eligibility Letter to GAMMIS Web Portal at mmis.georgia.gov |
If recipient needs emergency prescriptions, County designee should upload Form 962 to GAMMIS Web Portal at mmis.georgia.gov and include a note that recipient needs emergency prescriptions, |
After uploading Form 962, County designee can call the Member Contact Center to confirm receipt of 962 and request GAMMIS update using the dedicated DFCS line 1- 877-512-3130. |
A newly eligible Gateway A/R needs medical care or prescriptions before GAMMIS and Optum can update eligibility |
Check GAMMIS for eligibility. AND Upload a copy of Form 962 to GAMMIS Web Portal at mmis.georgia.gov for eligibility update. |
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Other situations |
Other than the situations mentioned above, it is appropriate to upload a Form 962 for an A/R ONLY in situations in which it is not possible to enter information into Gateway. These are: * Any month(s) over 13 months prior to current month * An AMN spenddown month which needs to have the first day liability amount decreased or the begin authorization date earlier than is shown in Gateway. Notify member using one of these methods: * Form 214 – Medicaid Notification Form (copy of form must be uploaded to Gateway.) * Gateway Manual Free Form Text |
Other Considerations
Claims or Billing Issue?
The Department of Community Health contracts with DFCS to perform correct eligibility determinations and to ensure those are transmitted correctly to the GAMMIS Web Portal. When the caseworker is contacted with a claims or billing issue, the caseworker should:
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Review all months of eligibility in Gateway for accuracy. This includes LA-D issues such as facility name, patient liability, etc. If the eligibility in Gateway is not correct, the caseworker should correct all affected months in Gateway.
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Review all months of eligibility on the GAMMIS Web Portal. If the eligibility in GAMMIS is not correct, the caseworker should complete and upload a Form 962 through the GAMMIS web portal. Enter case notes in Gateway for any actions that cannot be corrected in the system
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If Gateway and GAMMIS are correct, the caseworker should refer billing issues to Gainwell Technologies by directing the provider to use the Contact Us feature on GAMMIS to reach their provider rep.
For Providers:
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All providers can access the Provider Billing Manuals on GAMMIS at mmis.georgia.gov.
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Gainwell Technologies Provider Voice Response System: 1-800-766-4456
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Gainwell Technologies Contact Us link on GAMMIS: https:/mmis.georgia.gov
For Hospice Providers:
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Election, discharge, revocation, and transfer forms are faxed to Member Enrollment at 1-866-483-1045, ATTN: Member Enrollment.
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Providers should follow up with their field representatives whenever there is a problem, with proof of their submission.
| Member enrollment will update GAMMIS within 7 to 10 business days from date of receipt. |
For Members:
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Member information (non-eligibility specific) is found on mmis.georgia.gov
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Gainwell Technologies Member Contact Center: 1-866-211-0950
Problem Resolution
Manual Updates
Requests for manual updates that cannot be completed via Gateway must be uploaded to GAMMIS Web Portal via Form 962.
Gainwell Technologies will update GAMMIS within 3-5 business days.
Emergent Escalations
Caseworkers should use this email membernotification@dch.ga.gov for the following escalated or emergent issues:
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Member approved in Gateway but not showing on the portal and the member has a medical emergency
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Name misspelling/DOB/SSN mismatch, and if it is an emergency which prevents the member from receiving services.
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Duplicate ID’s
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Twins – only one showing up on the portal even though both are in Gateway
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Child put under wrong mother due to similar name or
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DOB with another child
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Optum Rx pharmacy updates/issues
Buy-In
Buy-in inquiries and data corrections should be submitted to the Gainwell Technologies Buy-In Unit at:
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FAX: 1-866-483-1045
Caseworkers should use the Form 703 - Medicare Buy-in Problem Template. Gainwell will send written response to DFCS of the action taken on the inquiry or discrepancy.
Buy-In requests not resolved through Gainwell Technologies should be sent to DCH Member Notification at membernotification@dch.ga.gov using Form 703 – Medicare Buy-In Problem Template.