GeorgiaProvider Enrollment - Frequently Asked Questions

Who needs to enroll in Georgia Medicaid?

Any provider who would like to receive Medicaid reimbursement for services rendered to Medicaid recipients. This includes rendering and billing providers, groups, and facilities.

I am currently enrolled as an active provider with Georgia Medicaid. Do I also need to enroll as an OPR provider?

No. Providers already enrolled as active Medicaid participating providers do not need to enroll again as OPR providers.

How do I enroll?

Georgia Medicaid has an online enrollment process. OPR providers may enroll in Medicaid through the Georgia Medicaid Management Information System (GAMMIS) Web Portal at: https://www.mmis.georgia.gov/portal/default.aspx.

Is there a separate enrollment process for OPR providers?

Yes. DCH has created online and paper applications strictly for OPR providers.

Will providers need a National Provider Identifier (NPI) number to enroll as an OPR provider?

Yes. The provider will need to obtain an individual NPI number before enrolling as an OPR provider. The federal government issues NPI numbers for health care providers at the following website: https://nppes.cms.hhs.gov/.

I am enrolled as a participating provider in another state’s Medicaid Program. Am I also required to enroll in the Georgia Medicaid program to provide services to Georgia Medicaid beneficiaries?

Yes. Enrollment in another state’s Medicaid program does not exempt an OPR provider from the requirement to enroll in the Georgia Medicaid program. As federally mandated, providers are required to enroll in each state where they order, prescribe, refer or render services to Medicaid enrollees. For example, if a physician located in Alabama and enrolled in the Alabama Medicaid program writes a prescription or orders a test for a Georgia Medicaid beneficiary, the Alabama physician must be enrolled in the Georgia Medicaid program or the claim submitted by the Georgia provider that filled the prescription or performed the test will be denied.

If a claim is rejected because the OPR provider is not currently enrolled in the Medicaid program, can the OPR provider enroll in the Medicaid program retroactively?

Yes. Please visit the Georgia Department of Community Health Georgia Medicaid Management Information System (GAMMIS) website to learn more about the Georgia Department of Community Health's retroactive enrollment policy.

If I receive a claim rejection due to the fact that the OPR is not enrolled in the Medicaid program, how long do I have to resubmit my claim?

Claims that have received a claim rejection for missing or invalid OPR must be resubmitted within the timely filling period. Claims submitted after then timely filling period, will be subject to a timely filling claim denial.

Who should I contact with further questions?

For questions concerning why Envolve requires providers to take this action, please contact Envolve Customer Service at (866) 458-2139.