Claims
System Overview & Access
The Georgia Department of Community Health (DCH) has selected Netsmart’s Mobile Caregiver+ (MCG+) as the state’s official Electronic Visit Verification (EVV) system, designed to capture real-time service data and help reduce fraud, waste, and abuse in home care.
Netsmart’s Mobile Caregiver+ (MCG+) is available to providers at no cost. While DCH allows approved third-party EVV vendors, any associated costs must be paid by the provider. Agencies should review their options to ensure compliance with state requirements.
EVV Support & Contact Information
Netsmart EVV Support
- Hours: Monday-Friday, 8:00 AM – 6:00 PM EST
- Phone: 1-833-483-5587
- Website: www.NetsmartConnect.com
- EVV Portal: https://evv-dashboard.mobilecaregiverplus.com
- User Guide Link: Mobile Caregiver+ Claims Console User Guide
Required Information for Support Tickets (L2/L3 Tickets)
- Agency Name
- Agency Medicaid ID
- Agency National Provider Identification (NPI) number
- Agency Employee Identification Number (EIN) or Taxpayer Identification Number
- Contact e-mail address
- Call back number
EVV Required Procedure Codes
The following waiver programs below are subject to EVV Program requirements:
- Service Options Using Resources in a Community Environment (SOURCE-COS 930)
- Community Care Services Program (CCSP-COS 590)
- New Options Waiver (NOW-COS 680)
- Comprehensive Supports Waiver Program (COMP-COS 681)
- Independent Care Waiver Program (ICWP-COS 660)
- Georgia Pediatric Program (GAPP-COS 971)
- EVV CPT Procedure Codes T1019 (PSS), T2025 (CLS), and S9122 (home health aide)
| Service | Code | Modifier 1 | Modifier 2 | Modifier 3 | Modifier 4 |
|---|---|---|---|---|---|
| Personal Support Services | T1019 | ||||
| Extended Personal Support | T1019 | TF | |||
| Consumer Direct PSS | T1019 | UC |
| Service | Code | Modifier 1 | Modifier 2 | Modifier 3 | Modifier 4 |
|---|---|---|---|---|---|
| Personal Support Level I | T2025 | U5 | TF | ||
| Personal Support Level II | T2025 | U5 | TG | ||
| Personal Support Consumer Directed | T2025 | U5 | UC | ||
| TBI Personal Support I | T2025 | U5 | U1 | TF | |
| TBI Personal Support Level II | T2025 | U5 | U1 | TG |
| Service | Code | Modifier 1 | Modifier 2 | Modifier 3 | Modifier 4 |
|---|---|---|---|---|---|
| Community Living Support Services | |||||
| CLS – 1 Member | T2025 | U4 | |||
| CLS – 1 Member | T2025 | U5 | |||
| CLS – 2 Member | T2025 | U4 | UN | ||
| CLS – 2 Member | T2025 | U5 | UN | ||
| CLS – 3 Member | T2025 | U4 | UP | ||
| CLS – 3 Member | T2025 | U5 | UP | ||
| Community Living Support Services – Self-Directed | |||||
| CLS – 1 Member – Self - Directed | T2025 | U4 | UC | ||
| CLS – 1 Member – Self - Directed | T2025 | U5 | UC | ||
| CLS – 2 Member – Self - Directed | T2025 | U4 | UN | UC | |
| CLS – 2 Member – Self - Directed | T2025 | U5 | UN | UC | |
| CLS – 3 Member – Self - Directed | T2025 | U4 | UP | UC | |
| CLS – 3 Member – Self - Directed | T2025 | U5 | UP | UC | |
| Community Living Support Services – Co-Employer | |||||
| CLS – 1 Member – Self - Directed | T2025 | U4 | UA | ||
| CLS – 1 Member – Self - Directed | T2025 | U5 | UA | ||
| CLS – 2 Member – Self - Directed | T2025 | U4 | UN | UA | |
| CLS – 2 Member – Self - Directed | T2025 | U5 | UN | UA | |
| CLS – 3 Member – Self - Directed | T2025 | U4 | UP | UA | |
| CLS – 3 Member – Self - Directed | T2025 | U5 | UP | UA |
| Service | Code | Modifier 1 | Modifier 2 | Modifier 3 | Modifier 4 |
|---|---|---|---|---|---|
| Personal Care Support | S9122 | ||||
| Personal Care Support using the Family Caregiver Option | S9122 | U2 |
| Service | Code | Modifier | Units Billed |
|---|---|---|---|
| Speech Therapy | 92507 | 1 unit per day | |
| Physical Therapy | 97161 | 1 unit per day | |
| Physical Therapy | 97162 | 1 unit per day | |
| Physical Therapy | 97163 | 1 unit per day | |
| Physical Therapy | 97164 | 1 unit per day | |
| Occupational Therapy | 97165 | 1 unit per day | |
| Occupational Therapy | 97166 | 1 unit per day | |
| Occupational Therapy | 97167 | 1 unit per day | |
| Occupational Therapy | 97168 | 1 unit per day | |
| Physical Therapy | 15 min | ||
| Physical Therapy | 59 | 15 min | |
| Occupational Therapy | 15 min | ||
| Occupational Therapy | 59 | 15 min | |
| Home Health Aide | 1 hour | ||
| Skilled Nursing | 1 hour | ||
| Skilled Nursing | 1 hour |
Prior Authorization (PA) & Units
- Case managers provide PA numbers for new members
- Providers must monitor approved vs. used units to avoid overages (PUNT errors)
- Contact the case manager for PA updates or issues
Voiding & Adjusting Claims
- Only paid or partially paid claims can be adjusted/voided
- Adjustments must follow Medicaid timely filing rules (90 days from paid date)
- Can not resubmit voided claim until next billing cycle
- EVV-released claims should not be adjusted in GAMMIS unless approved
Rounding Rules
The State EVV system, Netsmart, follows Medicaid rounding standards set by the Centers for Medicare & Medicaid Services (CMS). Service times of up to 7 minutes are rounded down, while 8 minutes or more are rounded up to the nearest 15-minute increment. For Personal Support Services (PSS) billed on an hourly basis, service times under 30 minutes are rounded down to the previous whole hour, and 30 minutes or more are rounded up to the next whole hour.
15-Minute Increment Billing:
- 1 unit: 8–22 minutes
- 2 units: 23–37 minutes
- 3 units: 38–52 minutes
- 4 units: 53–67 minutes
- 5 units: 68–82 minutes
- 6 units: 83–97 minutes
- 7 units: 98–112 minutes
- 8 units: 113–127 minutes
One-Hour Unit Billing:
- 1 unit: 30–60 minutes
Note: For more details, please refer to Rounding Rules Section 911 in the EDWP–CCSP and SOURCE General Services Policy Manual. Services that are not billed in 15-minute increments must instead follow the “Reimbursement Rates for CCSP and SOURCE” table provided in the Appendix.
Common Claim Denial Codes
- 512: Timely filing exceeded
- 535: Adjustment exceeds the timely filing limit
- 3000: Prior authorization (PA) units are exhausted or only partially available
- 3011: Date of service falls outside PA/precertification effective dates
- 4021: No coverage for the billed procedure
- 5035, 5037, 5042: Exact duplicate claim
- 5038, 5043: Potential duplicate claim
- 5044: Possible conflict with another waiver program
- 5115: Service not permitted during a hospital stay
EVV Claim Filing Deadlines
Weekly Deadline
- Claims must be submitted by Thursday at 11:59 PM for Friday payment cycles
- Claims submitted after Thursday will have their payment delayed by one week.
- Provider must have an L2/L3 Ticket from Netsmart to bill claims through GAMMIS.
Timely Filing
Claim Submission
- Initial claim: 6 months from the month of service
- One Year (365 days) Claim Submission: All claim submissions and adjustments to denied claims are to be completed according to policy by 365 days.
Claim Resubmissions
- Denied claims: within three months of the denial month
Claim Adjustments
- Claim adjustments: within three months of the payment month
Remittance Advice (RA)
Remittance Advice is issued weekly when there are claims activity during that cycle. It typically includes:
- Banner messages
- Claim activity and status details
- Financial transactions (expenditures and accounts receivable)
- Explanation of Benefits (EOB) descriptions
- Summary page
To access the RA in the Georgia Medicaid Management Information System (GAMMIS):
- Navigate to Reports, then Financial Reports
- Select Remittance Advice from the dropdown
- Enter the desired date range and click Search