Ga. Medicaid Part II Policies & Procedures for Hospital Services § 602

The successor provider must submit a new enrollment application and supporting documentation to

become effective at the time of the change of ownership. A change of ownership includes, but is not

limited to, a dissolution, incorporation, re-incorporation, and reorganization, change of ownership of

assets, merger, or joint venture whereby the provider either becomes a different legal entity or is

replaced in the program by another provider. (Rev 01/2015)

602.1. Any person or entity that is a Medicaid/Peach Care for Kids provider, and any person or

entity that replaces a provider, shall be deemed to have accepted joint and several liability,

along with its predecessor, for any overpayment and/or provider fee sought to be recovered

by the Division after the effective date of the successor provider’s enrollment, regardless of

the successor’s enrollment status or lack of affiliation with its predecessor at the time the

overpayment was made. An entity shall be deemed to have replaced a provider if it;

602.1.1. Effectively became a different legal entity through incorporation, re-incorporation,

merger, joint venture, dissolution, creation of a partnership, or reorganization,

602.1.2. Took over more than fifty percent (50%) of the predecessor’s assets,

Medicaid/PeachCare for Kids clients, or Medicaid/PeachCare for Kids billings

602.1.3. Or has substituted for the predecessor in the program, as evidenced by all

attendant circumstances.

Reimbursement for services rendered prior to the effective date of enrollment of a successor provider

(including any adjustments for underpayments made by the Division) shall be made to the provider

of record at the time the payment is made or to that provider’s payee as properly designated on the

appropriate form(s) required by the Division. Any dispute or conflict legal or otherwise, arising

between the currently enrolled provider and the predecessor provider concerning either

apportionment of liability for any overpayment previously made by the Division or the right to

additional reimbursement for any underpayments previously made by the Division shall be the sole

responsibility of such parties and shall not include the Division

602.1.4. Upon completion of the change of ownership or legal status enrollment

application, the predecessor’s provider number will be the same base nine-digit

provider number as the successors with a unique suffix identifying the service

location, e.g. 123456789B. The Department shall authorize this only in situations

in which the predecessor and successor’s category of service are the same

602.1.5. Should the predecessor and successor’s category of service not be the same, the

new owner applying for enrollment may not request a change of the predecessor’s

provider number without the express consent of the Chief of the Division of

Medical Assistance

602.1.6. To allow for continuity of care and timely filing of claims, the successor shall

submit claims using the predecessor’s provider number while the Change of

Ownership enrollment application is being processed. Failure to submit claims in a

timely manner pursuant to Chapter 200 of this Part may result in denial of claims.

Until the Change of Ownership is completed, claims will be processed, and

payment will be made to the predecessor’s payee number