What can a billing guarantee cover, and what can it not?
A fair billing guarantee covers work the biller controls: sending claims without errors the biller causes, and fixing those errors at no charge. It cannot cover the payer’s decision. Medicaid can still deny for eligibility, authorization or program rules. Read the exact wording and the exclusions.
A guarantee is only as strong as its wording. Look for what is promised and what is carved out.
What a billing company can control:
- Entering the data correctly.
- Checking each claim against the authorization before it goes out.
- Meeting filing deadlines.
- Correcting its own mistakes without charging you again.
What no one can promise:
- That Medicaid will pay. Georgia says prior authorization itself does not guarantee payment.
- That the client stays eligible.
- That the care was authorized or documented. Bad notes or a missing EVV record can sink a claim.
- How fast the state pays.
Red flags: promises of a payment rate, promises that cover payer decisions, or language you cannot find in the contract.
Good questions: What exactly is guaranteed, in percent and in what time? Which claims count? Who decides if an error was theirs? What is the remedy?
The agency still owns the quality of its visit records.
How CareBravo® helps
Managed Billing carries a written 99% guarantee: at least 99% of eligible original claims go out without an error we cause; payer decisions are not guaranteed; corrections are free.
Sources
- Georgia Medicaid Common Denials webinar (Feb 2021) · Georgia DCH / GAMMIS
- Electronic Visit Verification (EVV): Provider-related FAQs · Georgia DCH
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
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