What is prior authorization?
Prior authorization (PA) means the carrier must approve certain care before it happens. A PA denial is different from a claim denial after care was provided.
Overview for any state: Prior authorizations. This page is Georgia-only.
Confirm plan type: Georgia: Start Here.
Georgia PA deadlines
Georgia's Ensuring Transparency in Prior Authorization Act (O.C.G.A. Title 33, Chapter 46, Article 2) sets timelines for insurers and private review agents:
Non-urgent services
- Notify the provider of approval or denial within 7 calendar days of obtaining all information needed (§ 33-46-26)
- Clinical criteria for any adverse determination must be provided to the provider at notification
Urgent services
- Decision and notice within 72 hours of receiving all information needed (§ 33-46-27)
Stability & continuity
- If care starts within 45 business days of PA approval, the insurer generally cannot revoke or restrict authorization except for fraud, material misrepresentation, or loss of coverage (§ 33-46-23)
- Chronic medication PA: often valid up to one year while therapy continues (§ 33-46-23.1)
- When switching plans, prior PA from a previous insurer may continue 30 days (§ 33-46-28)
Insurers must post current PA requirements and denial statistics on their websites (§ 33-46-20).
Where to look up PA rules
Match tools to the exact plan on the ID card:
- Anthem Blue Cross Blue Shield of Georgia: anthem.com/georgia
- Kaiser Permanente Georgia: kaiserpermanente.org — Georgia
- Ambetter / other Georgia Access plans: check your issuer portal
Georgia Medicaid
Medicaid PA follows CMO and DCH rules—not commercial Chapter 46. Service denials: CMO grievance, then fair hearing—see your CMO member materials.
If PA is denied
- Get the adverse determination in writing with clinical criteria cited.
- Ask the treating clinician for records and a medical-necessity letter.
- File an internal appeal—see Georgia internal appeals.
- If care cannot wait, request expedited review.
Building a strong appeal packet has a checklist.
Urgent care
Use the 72-hour PA rule. For urgent denials, request expedited internal and external review—see Georgia external review.