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Official Code of Georgia Annotated

Title 31. HEALTH · Chapter 53. OFFICE OF HEALTH STRATEGY AND COORDINATION · Article 3. GEORGIA ALL-PAYER CLAIMS DATABASE

31-53-47. Submission of claims; personal identification data not public record.

Active

Current through: Including Acts of the 2025 Session of the General Assembly of Georgia.

  1. (a)

    Beginning in January, 2023, and every month thereafter, all submitting entities shall submit claims data for state residents to the GAPCD in accordance with this article and rules and regulations promulgated pursuant to this article.#

  2. (b)

    Submitting entities shall submit 95 percent of data within 60 days from the day that the adjudicated claims were paid and 100 percent of data within 180 days from the day adjudicated claims were sent for payment. The administrator shall establish a data submission guide to ensure uniformity of data, which may be based on currently existing data standards, such as the National Council for Prescription Drug Programs (NCPDP) and ASC X12 Post Adjudicated Claims Data Reporting (PACDR).#

  3. (c)

    Self-funded employer sponsored plans may voluntarily submit monthly claims data to the GAPCD when the employer has opted in writing to the submission of the data. The carrier or administrator shall notify the employer of the employer’s option to authorize the submission of the data.#

  4. (d)

    Direct personal identifiers contained in claims data submitted pursuant to this article shall not be considered a public record and shall not be subject to Article 4 of Chapter 18 of Title 50, relating to open records.#

The notes below are printed with the section but are not enacted law (O.C.G.A. § 1-1-1(c)). They are shown apart from the text.

History

Code 1981, § 31-53-47, enacted by Ga. L. 2020, p. 743, § 1/SB 482; Ga. L. 2025, p. 1029, § 31(72)/SB 153, effective July 1, 2025.

Amendments

The 2025 amendment, effective July 1, 2025, part of an Act to revise, modernize, and correct the Code, in subsection (b), deleted a comma following “paid” in the first sentence and substituted “data submission guide” for “Data Submission Guide” in the second sentence; and substituted “claims” for “claim” in subsection (d).

Read the official page (the state's PDF, opened at the page this text was read from).

Current through: Including Acts of the 2025 Session of the General Assembly of Georgia.

Text read from t31-(v23)-2025-pdf.pdf, Volume V23, 2025 edition, pages 1113 to 1114; merge action: bound only; file SHA-256 ba5a57f85d04.