Georgia Out-of-Network Mental Health Billing: 5 Easy Steps
Georgia out-of-network mental health billing is how you get paid when you are not in a payer’s network. You can file the claim yourself, hand the client a superbill to file, or skip insurance and charge a self-pay fee. Each route has its own paperwork. This guide covers the Georgia points that matter for each.
Three ways to get paid out of network
In Georgia out-of-network mental health billing, choose the route per client and write it down. The route decides who files, who gets paid, and what you must have on file.
| Route | Who files | Who the payer pays | What you need |
|---|---|---|---|
| Provider files with assignment | You | You, or you and the client jointly | Signed assignment of benefits and written notice to the payer |
| Client files with a superbill | Client | Client | A complete superbill |
| Self-pay, no claim | No one | You | A good faith estimate |
Georgia out-of-network mental health billing and assignment of benefits
State rules
O.C.G.A. 33-24-54 deals with payment to providers outside a plan’s network. In the 2006 text we could open, a payer must pay a nonparticipating provider in certain cases. The provider must be similarly licensed, must have rendered the service, must hold a written assignment of benefits, and must have given the payer written notice of that assignment. The payer may then pay the provider directly or pay the provider and the covered person jointly.
The same section says it does not stop a plan from offering different benefit levels or coinsurance for in-network and out-of-network providers. Newer versions of the code exist, so read the current text or ask counsel before relying on this summary.
Private payers: what the plan will pay
Check the out-of-network benefit before the first visit. Ask whether the plan has an out-of-network deductible, what coinsurance applies, and what allowed amount it uses. A plan pays a percentage of its allowed amount, not your fee, so explain that to the client before you begin. Our benefit verification questions cover the rest.
Whether you may collect the difference between your fee and the allowed amount depends on your status with the plan and your contract. Read our balance billing guide and ask your counsel when you are unsure.
Medicare and Medicaid
Georgia Medicaid is different. The Part I manual says a participating individual practitioner accepts Medicaid payment as payment in full, apart from authorized copays. If you do not accept a person as a Medicaid member, the manual allows private pay only after you disclose the names of two other providers who are likely to accept the person, and the person agrees in writing. CareSource says it will not pay for dates of service before credentialing approval. Treat Medicaid as a network program, not an out-of-network one, and read the manual before you accept private pay.
Self-pay clients in Georgia out-of-network mental health billing
Federal guidance calls a client self-pay if the client has coverage but does not plan to file a claim for the service. The December 1, 2021 federal FAQ says you must give a good faith estimate for care scheduled at least three days ahead, and that no specialty is exempt. Put the estimate in your intake packet.
What is the best way to handle Georgia out-of-network mental health billing?
For Georgia out-of-network mental health billing, pick one standard route and apply it to every new client. Most practices either file the claim with a signed assignment or give a superbill each month. Whichever you choose, verify the benefit first, explain the plan’s share in writing, and keep copies of every document.
What to do Monday morning
Put your Georgia out-of-network mental health billing in order with these steps.
- List your clients who are out of network and the route you use for each.
- Check that every claim you file has a signed assignment of benefits on file.
- Update your in-network and out-of-network decision for each payer.
- Review your intake packet for the good faith estimate and the superbill instructions.
- Pull your unpaid out-of-network claims and follow up.
The short version: Georgia out-of-network mental health billing
Georgia out-of-network mental health billing works in three ways: you file with a signed assignment, the client files with a superbill, or the client pays you directly after a good faith estimate. Verify the benefit first and keep your paperwork complete.
How MCM South helps
MCM South Medical Billing Service, LLC bills exclusively for mental and behavioral health. We work with psychotherapists and psychiatrists in solo and medium-size practices, and we bill out-of-network claims for clients. Out-of-network claims have their own rules, and we handle that work for clients.
Keep going
Related reading
Ready to hand off the billing side? We can talk through your practice.
FAQ
Can a Georgia insurer pay me directly if I am out of network?
The 2006 text of O.C.G.A. 33-24-54 says a payer may pay a nonparticipating provider directly or jointly with the insured when the provider holds a written assignment and has given the payer written notice. Read the current text before relying on it.
Do I have to give a good faith estimate to every out-of-network client?
Federal guidance requires one for uninsured or self-pay clients when care is scheduled at least three days ahead. A client who has coverage but will not file a claim counts as self-pay. Ask counsel how it applies to your intake.
Can I treat a Georgia Medicaid member as out of network?
Georgia Medicaid is a network program. The Part I manual says you may accept a person as private pay only after disclosing two other likely providers and getting the person’s written agreement. Read the manual first.
What should be on a superbill?
Use a complete template that lists your provider details, diagnosis, service codes and fees. See our superbill template for the layout.
Where MCM South works
MCM South Medical Billing Service, LLC works with psychotherapists and psychiatrists in our ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. We serve solo and medium-size practices that bill mental and behavioral health. Founder Michael Williams has worked with insurance payers in all 50 states. Browse the state and regional billing guides for rules that vary by state, or see our billing services.
This post is operational guidance for billing, not legal advice. Rules change, so confirm with the payer or your counsel.
