Third-Party Liability

Third-Party Liability/Coordination of Benefits (TPL/COB)

Georgia Medicaid members who have private health insurance coverage may contact their local county Division of Family and Children Services (DFCS) to provide any new or updated information concerning their health insurance coverage. Examples of an update to report include a change in your private insurance (new or existing coverage), termination of coverage, or the addition or removal of  a member(s).

You should Download this pdf file. complete the DMA-285 form for any updates or new insurance information that you need to report. Please submit the information by using one of the following methods:

You may contact the TPL/COB Unit at Gainwell Technologies for immediate updates at:  

Phone: 678-564-1162, Press 3
Fax: 770-980-0180
Email: [email protected]

Georgia Department of Community Health
100 Crescent Centre Parkway
Tucker, GA 30084

Or Division of Family and Children Services (DFCS)
Georgia Gateway website: https://gateway.ga.gov/access/
DFCS Contact number: 1-877-423-4746

If the member is covered by one of the CMOs, and the TPL record needs to be updated, please send those insurance update requests to the TPL Unit to coordinate the verification with the appropriate CMO Plan and update GAMMIS at TPL.InsuranceUpdates@dch,ga.gov.

Third-Party Liability - Related Links

  • Medicaid Subrogation, Estate Recovery and Special Needs Trust

    Georgia Medicaid’s Subrogation, Estate Recovery and Special Needs Trust programs are administered by Health Management System (HMS). The Department of Community Health (DCH) oversees the administration of Georgia’s Medicaid and PeachCare for Kids® programs. HMS contracts with DCH to operate the Subrogation Unit, Estate Recovery Unit and Trust Unit.

  • Medicaid Estate Recovery

    Estate recovery is a program, required by federal law, whereby Medicaid members with qualified assets reimburse the taxpayers for long term care and home and community-based services provided through Medicaid.

  • Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA)

    Georgia Medicaid members may be eligible for the CHIPRA Premium Assistance Program if they are 19 years of age or younger and have access to their or their parent’s employer group health plan and those whose employers contribute at least 40 percent towards the cost of the premium.

  • Health Insurance Premium Payment Program (HIPP)

    Georgia Medicaid members who work may be eligible for premium assistance through a Medicaid program called the Health Insurance Premium Payment Program (HIPP).

  • Third-Party Liability Services Procurement

    The State of Georgia (Lead State), Department of Administrative Services (DOAS), State Purchasing Division (SPD) is requesting proposals for Third Party Liability Services (TPL) in furtherance of the NASPO ValuePoint Cooperative Purchasing Program.

  • Program Integrity Utilization Review Program (PDF, 173.54 KB)

    The objective of the Program Integrity Utilization Review program is to identify and recover payments made to Medicaid providers that do not meet state and federal requirements. Audits, include coding validation, payment accuracy, compliance with state and federal regulations, policies, contractual requirements, and utilization standards.

Credit Balance Audit Reporting

A credit balance (CB) is an accounting term describing a situation in which the sum of adjustments and payments exceeds total charges for a claim. The objective of credit balance is to identify overpayments to made to providers by Georgia Medicaid through a claim level review of outstanding accounts. The Department’s goal is to identify and recover credit balances through on-site reviews, desk reviews, and provider self-audits to ensure all accounts which reflect Georgia Medicaid credit balances are reported to DCH. All Medicaid providers are required to review their records for any outstanding credit balances on a quarterly basis. Hospitals and nursing facilities are required to submit  these quarterly reports even if a zero credit balance exists. All other providers should complete this form only when reporting an outstanding credit balance. The report must be sent no later than 30 days following the end of each calendar quarter (September 30, December 31, March 31, and June 30). The Medicaid Credit Balance Form, Download this pdf file. DMA-710 , is for the purpose of monitoring and recovering “credit balances” owed to Medicaid. Failure to submit a Medicaid Credit Balance Report could result in withholding of the Medicaid payments until the report is received. The provider could also be subjected to a complete on-site audit and/or assessed additional monetary penalties. *Medicaid Manual Part 1, Policies and Procedures for Medicaid _PeachCare for Kids, Section 303.8*. 

You may contact the Credit Balance Audit Unit at Gainwell Technologies for immediate updates at:

Email: [email protected]    

Telephone: 404-445-0451                                                                                                                         

Georgia Department of Community Health

Attn: Credit Balance Unit

100 Crescent Centre Parkway

Tucker, GA 30084