Ga. Medicaid Part II Policies & Procedures for Hospital Services § 906

Prior to July 1, 1991, hospital providers were given the option of billing for hospital-based physicians’

professional services on the hospital claim form. Effective dates of service July 1, 1991, and after, all

hospital-based physicians must be enrolled in the Physician Services. Program and all inpatient and

outpatient professional services must be billed on the physician’s claim form.

Prior to July 1, 1993, services provided by certified registered nurse anesthetists (CRNAs), nurse

practitioners and physician’s assistant anesthesiologist’s assistants (PAAAs) could be billed on the

hospital claim form. Effective dates of service July 1, 1993, and after, all CRNAs, pediatric nurse

practitioners, obstetrical nurse practitioners, family nurse practitioners and PAAAs must enroll in the

appropriate practitioner program within the Division of Professional Services.

Effective dates of service January 1, 1994, and after, adult and gerontological nurse practitioners

must enroll in the appropriate practitioner program within the Division of Professional Services. All

inpatient and outpatient services must be billed in accordance with the policies and procedures for the

specific program.

Hospital-based physicians, CRNAs, specified nurse practitioners and PAAAs may designate the

hospital as payee by agreement. The hospital must maintain each agreement authorizing such

payments on file and submit a copy to the Provider Enrollment Unit at the address included in Part

I, Section 105.

Services rendered to eligible members by hospital-based physicians, CRNAs, designated nurse

practitioners and PAAAs will be covered both on an inpatient and outpatient basis as long as the

services are medically necessary and within the contractual or financial agreement with the hospital.

These services are subject to retrospective review by the Division or its authorized agents.