GSHA CMO Denials Form

Medicaid Denial Questionnaire

GSHA representatives Donna Davidson and Jennifer McCullough are continuing lobbying efforts to improve the therapy situation for the children receiving Medicaid in Georgia. In an effort to understand the magnitude of denials and barriers to services for the children receiving Medicaid, please help GSHA by answering the following questionnaire. The results will be used in lobbying efforts with Georgia Medicaid and the Centers for Medicaid Services (CMS) to explain how the CMO implementation and the Prior Approval process are causing barriers getting the necessary services to the children who need them. They also may be violating federal Early Periodic Screening and Detection (EPSDT) mandates.


Name of Treating Therapist:
Address:
Phone:
E-mail:

Number of CMO children being treated:
Of the CMO children being treated, how many initial denials did you receive when sending in prior authorization?
Of those denied, how many were denied for technical reasons?
Of those denied, how many were denied for treatment reasons?
Number of children under Aged Blind and Disabled being treated:
Of the children under Aged, Blind, and Disabled, how how many initial denials did you receive when sending in prior authorization?
Of those denied, how many were denied for technical reasons?
How many of the above were approved after appealing?
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