Licensing the Georgia Fee Schedule is based on the number of users in your organization.
A User is an individual who uses information from the ground rules and/or rate tables to make decisions about, to charge or to pay for services related to claims for injured workers in Georgia.
A physician practice using the fee schedule to bill for services provided to a patient who was injured at work
Anyone adjudicating a bill whereby the fee schedule is used to price services
A business analyst interpreting rules and regulations for automation into a software program for bill adjudication or other processing needs
A claims processor at an insurer/TPA/bill review agency who is reviewing a workers’ compensation bill to evaluate appropriate review or payment for medical services
Reviewing a bill for the purposes of adjusting or completing a potential re-evaluation due to errors, a state or hearing directive or a provider dispute
Reviewing the fee schedule information for purposes of preparing litigation, attending a hearing or arbitration
The following are examples of individuals who would NOT be considered Users of the fee schedule:
IT staff who load the fee schedule to a company’s computer system or software program for use by claims processors or bill reviewers, running reports or other IT functions
Quality assurance staff who review rates to ensure they are properly reflected in an organization’s internal systems
A physician’s billing manager, who bills for workers’ compensation claims on behalf of the physician/practice
Customer service representatives or other individuals who access information from an Explanation of Review or other secondary documentation as a result of application of the fee schedule