Georgia Medicaid

Overview

State Medicaid program. Theoria’s Southeast H + Midwest M entities have been stuck in repeated denial cycles since mid-2025.

Submission via state portal; effective dates and enrollment letters issued separately. Retro-submission requires payer-portal action.

Repeated rejections of same documents — Theoria Midwest M denied 4/6 over business license; Secretary of State certificate, bank letter, and other docs rejected again on resubmission. Ownership-staff complaint received 4/9 demanding board-of-directors listing — entity is 100% owned by single person, corp election for tax only, no board exists.
Email forwarding gap — 4/9 GA Medicaid email never forwarded to Svetlana; she would have responded same day.
Inconsistent retro denials — first round denied for >6mo retro request; second round denied for “untimely” filing despite original 9/25 submission being within 60-day deadline.

2026-04-17 — PE team confirmed retro window is 60 days from welcome letter date, not effective date. Source: Svetlana + Amy in 17 sync.

Retro window: 60 days from welcome letter date (not effective date)
Max retro lookback: 6 months from welcome letter
Submission: portal-only (no form/email submission)
Re-submission risk: GA Medicaid will not adjust prior request once denied per Amanda’s 4/15 investigation — proof-of-timely-filing must be re-pushed at original-submission date

Theoria Medical — Southeast H pending docs, Midwest M repeatedly rejected, ~$100K AR exposure on retro dispute

2026-04-14 — Theoria Cred Hold sync — Amy explained two-failure retro pattern
2026-04-15 — Complex weekly sync — business license + Secretary of State + ownership rejections
2026-04-17 — Theoria weekly sync — Derek-vs-Svetlana retro-window dispute, factual timeline