CMO Reviews and Reports
Managed Care Periodic Audit Reports
Per federal regulations, the Department of Community Health must periodically, but no less frequently than once every three years, conduct or contract for an independent audit of the accuracy, truthfulness, and completeness of the encounter and financial data submitted by, or on behalf of each Care Management Organization (CMO) and post the results of these audits on our website. 42 CFR§ 438.602(e) and (g).
Agreed-Upon Procedures Reports
These reports are conducted by an independent auditor to evaluate the Care Management Organizations (CMOs) contract compliance, program integrity (PI) oversight, subcontractor oversight, and encounter submissions
- Amerigroup AUP Report - Posted 10/04/23
- CareSource AUP Report - Posted 10/04/23
- Peach State Health Plan AUP Report - Posted 10/04/23
Encounter Data Reports
“Encounter data” are claims that have been paid by CMO’s or delegated vendors (e.g., dental, vision, and pharmacy) to health care providers that have rendered health care services to members enrolled with the CMO.
- GA CMO Encounter Report - Amerigroup Georgia Families and Georgia Families 360° October 2021 thru September 2023 - Posted 12/29/23
- GA CMO Encounter Report - Amerigroup Georgia Families and Georgia Families 360° August 2021 thru July 2023 - Posted 10/04/23
- GA CMO Encounter Report - Amerigroup Georgia Families and Georgia Families 360° June 2021 thru May 2023 - Posted 10/03/23
- GA CMO Encounter Report - Amerigroup June 2021 thru May 2023 - Posted 10/03/23
- GA CMO Encounter Report - Amerigroup April 2021 thru March 2023 - Posted 06/20/23
- GA CMO Encounter Report - Amerigroup February 2021 thru January 2023 - Posted 04/19/23
- GA CMO Encounter Report - Amerigroup December 2020 thru November 2022 - Posted 02/07/23
- GA CMO Encounter Report - Amerigroup October 2020 thru September 2022 - Posted 12/13/22
- GA CMO Encounter Report - Amerigroup August 2020 thru July 2022 - Posted 12/13/22
- GA CMO Encounter Report - CareSource October 2021 thru September 2023 - Posted 12/29/23
- GA CMO Encounter Report - CareSource August 2021 thru July 2023 - Posted 10/04/23
- GA CMO Encounter Report - CareSource June 2021 thru May 2023 - Posted 10/03/23
- GA CMO Encounter Report - CareSource April 2021 thru March 2023 - Posted 06/20/23
- GA CMO Encounter Report - CareSource February 2021 thru January 2023 - Posted 04/19/23
- GA CMO Encounter Report - CareSource December 2020 thru November 2022 - Posted 02/07/23
- GA CMO Encounter Report - CareSource October 2020 thru September 2022 - Posted 12/13/22
- GA CMO Encounter Report - CareSource August 2020 thru July 2022 - Posted 12/13/22
- GA CMO Encounter Report - Peach State October 2021 thru September 2023 - Posted 12/29/23
- GA CMO Encounter Report - Peach State August 2021 thru July 2023 - Posted 10/04/23
- GA CMO Encounter Report - Peach State June 2021 thru May 2023 - Posted 10/03/23
- GA CMO Encounter Report - Peach State April 2021 thru March 2023 - Posted 06/20/23
- GA CMO Encounter Report - Peach State February 2021 thru January 2023 - Posted 04/19/23
- GA CMO Encounter Report - Peach State December 2020 thru November 2022 - Posted 02/07/23
- GA CMO Encounter Report - Peach State October 2020 thru September 2022 - Posted 12/13/22
- GA CMO Encounter Report - Peach State August 2020 thru July 2022 - Posted 12/13/22
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GA
CMO Encounter Report - Wellcare October 2020 thru September 2022
- Posted 12/13/22
- GA CMO Encounter Report - Wellcare August 2020 thru July 2022 - Posted 12/13/22
CMO Flash Reports
The Care Management Organization (CMO) Flash Report provides a quick reference overview of the Georgia Families program, including member enrollment, CMO financial filings with the Department of Insurance, CMO self-reported utilization data, prior authorization performance, timely access performance and trends to watch.
Click the links to the left to review CMO Flash Reports from 2018 to the present.