Georgia's Trusted Healthcare
& Medical Provider Attorneys

Tips on How to Request Medicaid Hearings in Georgia (Part III of III)

In the final part of our “How to Request Medicaid Hearings in Georgia” series, a final tip in this process is to make sure you’re well versed in your policies AND the Department of Community Health’s (DCH’s) policies.  While you may understand and know your own internal policies extremely well, it may be helpful to hire a healthcare attorney that specializes in and has experience with DCH’s policies and administrative appeals to ensure the best possible outcome of your hearing.

Knowledge of the facts and your and DCH’s policies are critical.

For the hearing:

  • Make sure you know the member
  • Determine what the medical records do and do *not* say
  • Identify if information used by DCH was correct
  • Determine if anything has changed

 

Again, here’s where engaging a healthcare attorney with experience in administrative hearings will be helpful.

Finally,  being proactive will help you minimize the amount of money lost to denied claims and increase your effectiveness in challenging denials issued by the Department.

Jeyaram & Associates has successfully handled more than 200 Medicaid hearings before the Georgia Department of Community Health and is well positioned to help with your administrative hearings. Contact DJ@Jeylaw.com

 

Tips on How to Request Medicaid Hearings in Georgia (Part II of III)

This post is the second in a three part series about how to request Medicaid Hearings in Georgia.Georgia Medicaid Hearing

Planning and preparing is always important, but the one of most important steps is making sure your Request for Hearing is submitted to the Department on time.

Once a hearing has been requested, it becomes even more important to make sure you have a plan in place.

• Providers can represent members at hearings (federal law)

• Get written authorization to represent

• Ask “Why” 10x. . . And then ask 10x more! (Then “how” and “what”)

• Rates can be provider or member appeals

• Meet all deadlines for filing

• Ask for all documents to be used by the other side at the hearting (subpoena)

• Make the state prove each piece of its reduction/denial

Here are some tools that you can leverage during this process:

Subpoenas

  • Can subpoena documents or people
  • Must be reasonable to the case
  • Can get form from OSAH
  • Must be served by certified or registered mail 5 days before hearing
  • See OSAH Rule 19

 

Request a Pre-hearing conference with ALJ

  • Request a Pre-hearing Order
  • Exhibit exchange
  • Witness lists

 

One of the best ways to help you navigate through this process is to engage a lawyer that specializes in healthcare, specifically Medicaid Hearings to help ensure the best possible outcome.

Next week, we’ll post the final tips segment on how to request Medicaid Hearings. www.jeylaw.com