Georgia Medicaid Third-Party Administrators: Who Runs What (2026)

Your Georgia Medicaid card says one plan, but that one card routes to several different companies called third-party administrators. Your medical care runs through a Care Management Organization (CMO), but dental, vision, rides, and prescriptions each run through a separate Georgia Medicaid third-party administrator. Each one has its own provider directory, its own phone line, and its own appeal path. This guide names which company runs each Georgia Medicaid benefit in 2026, explains why the state splits them up, and tells you which one to call for which problem.

In This Guide

• Key Takeaways
• What a Georgia Medicaid Third-Party Administrator Is
• Who Runs Each Georgia Medicaid Benefit
• Rides: Verida Replaced Modivcare in 2026
• Dental and Vision: What Your Plan Covers
• Pharmacy: OptumRx and Your Plan's Manager
• Which Company Do I Call?
• When a Benefit Crosses Two Companies
• How to Appeal a Denial
• Frequently Asked Questions
• Learn More

What a Georgia Medicaid Third-Party Administrator Is

A third-party administrator (TPA) is a company that runs a specific benefit on behalf of Georgia Medicaid without taking on the full insurance risk a health plan carries. The state carves certain benefits out, meaning it pulls them out of the Care Management Organizations (CMOs) that run medical and behavioral health, and contracts each carved-out benefit to a separate administrator. Dental, vision, non-emergency medical transportation, and pharmacy are the benefits most commonly handled this way.

The practical result is the gap many families hit: you are told you have "Georgia Medicaid managed care," but in practice you call one company for medical care, a different company for dental, a third for vision, a transportation broker for rides, and a pharmacy administrator for prescriptions. Each has its own network, its own directory, and its own complaint process. No single company owns the coordination when a need crosses two of them.

The split exists for administrative reasons, not to make navigation harder. Carving out dental and vision lets the state contract with networks of dentists and optometrists who work separately from the medical provider community. Carving out transportation centralizes ride scheduling under one broker. Carving out pharmacy lets a specialized administrator run the drug list, prior authorizations, and point-of-sale claims. The trade-off is fragmentation, and the point of this guide is to map it so you know who to call.

Who Runs Each Georgia Medicaid Benefit

The table below names the administrator for each Georgia Medicaid benefit category in 2026. Some benefits are run through a single statewide broker, while dental and vision are tied to your specific CMO.

To find the exact vendor names and phone numbers that apply to you, check the back of your Medicaid card and your plan's member handbook, or call your CMO's member services line. The CMO directories are at Amerigroup Community Care, CareSource Georgia, and Peach State Health Plan.

Rides: Verida Replaced Modivcare in 2026

Non-emergency medical transportation (NEMT) is a required Medicaid benefit: states must provide rides to and from covered medical care for members who have no other way to get there. In Georgia, the Department of Community Health (DCH) administers the benefit through a single statewide broker.

As of April 1, 2026, that broker is Verida (formerly Southeastrans), and it covers all five Georgia regions: North, Atlanta, Central, East, and Southwest1. Modivcare, which previously served part of the state, no longer provides Georgia Medicaid NEMT in the Central, Southwest, and East regions, and Verida now covers all five1. If you have an old member handbook or a saved phone number for Modivcare, it is out of date. Use the current contact on the DCH non-emergency medical transportation page or in your current plan handbook.

NEMT covers rides to Medicaid-covered services, including medical and specialty appointments, behavioral health visits, dialysis, and hospital discharge. Available ride types include ambulatory (sedan or van), wheelchair-accessible vehicles, and stretcher transport for members who cannot sit upright. Advance-notice windows, dialysis standing schedules, and same-day discharge rules are set by the broker, so confirm the current rules with Verida or on the DCH transportation page before you book. For deeper detail on scheduling and complaints, see the dedicated Georgia Medicaid non-emergency medical transportation guide.

Dental and Vision: What Your Plan Covers

Dental and vision are carved-out benefits, but in Georgia they are administered through your CMO's contracted vendor rather than through one statewide carve-out company. DentaQuest administers dental for some plans and Avesis administers vision for some plans; the vendor that applies depends on which CMO you are enrolled in2. Confirm your dental and vision vendor through your plan's member handbook or member services line.

What the benefit covers depends on age. For children under 21, the federal Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) mandate requires comprehensive dental and vision coverage, including exams, cleanings, fillings, medically necessary orthodontics, eye exams, and eyeglasses. EPSDT requires all medically necessary services to correct or improve a condition found during a screening, even when that service is not part of the adult benefit.

For adults age 21 and older, Georgia expanded its Medicaid dental benefit effective July 1, 2024 through State Plan Amendment GA-24-00053. Before that change, most adults were covered only for limited oral evaluations and emergency extractions; the expansion added comprehensive services, including oral evaluations, cleanings, fluoride, fillings, crowns, anterior and posterior root canal therapy, and complete and partial dentures, subject to frequency limits and prior authorization for some procedures3. If an older guide tells you adult Georgia Medicaid dental is emergency-only, it predates this 2024 expansion. Adult vision remains narrower, covering medically necessary services such as diabetic eye exams and care tied to eye disease. For full coverage detail, see the Georgia Medicaid dental coverage and Georgia Medicaid vision coverage guides.

Pharmacy: OptumRx and Your Plan's Manager

How your prescriptions are administered depends on how you are enrolled. For fee-for-service members, OptumRx is Georgia's pharmacy benefits manager (PBM) for the Medicaid fee-for-service outpatient pharmacy program, and it processes those claims at the point of sale4. Members enrolled in a CMO get their pharmacy benefit through that CMO and its own pharmacy benefits manager, not through OptumRx4.

A pharmacy benefits manager runs the network of participating pharmacies, processes claims, administers the preferred drug list and prior authorization rules, and operates the prescriber and member call lines. If a prescription is rejected at the counter, ask the pharmacist for the rejection reason (prior authorization required, step therapy, quantity limit, or non-preferred drug), then contact your prescriber to address it. For the full drug-benefit walkthrough, see the Georgia Medicaid pharmacy benefit manager guide.

Which Company Do I Call?

Knowing which administrator owns your problem saves the most time. Match your need to the right contact:

• Dental: call your CMO's dental vendor (your handbook names it), or your CMO member services if you are unsure which vendor applies.
• Vision: call your CMO's vision vendor, or your CMO member services.
• Rides: call Verida, the statewide transportation broker, using the current number on the DCH transportation page.
• Prescriptions: call your CMO's pharmacy member services if you are in a plan, or the fee-for-service pharmacy line if you are fee-for-service.
• Not sure who covers something: call your CMO member services or DCH Member Services, which can route you.

When you call about a ride, have your Medicaid ID, the appointment date, time, and address, the provider name, your pickup address, and any wheelchair or mobility needs ready.

When a Benefit Crosses Two Companies

The hardest cases are the ones that fall between two administrators. A child's extensive dental work may need general anesthesia: the dental treatment is the dental vendor's responsibility, but the anesthesia and surgical center are the CMO's. A hospital discharge with follow-up rides requires the discharge planner, the CMO, and the transportation broker to coordinate. A drug that is billed as a medical benefit rather than a pharmacy benefit can stall between the pharmacy administrator and the CMO.

When a need crosses two companies, ask your CMO or DCH Member Services to coordinate, and confirm every authorization is in place before the procedure or trip. Document each call (date, who you spoke with, what they said) so you have a record if the handoff fails.

The federal access standards that govern these administrators were strengthened by the CMS Medicaid and CHIP Managed Care Access, Finance, and Quality Final Rule (CMS-2439-F), published May 10, 2024 and effective July 9, 20246. The rule sets maximum appointment wait-time standards, requires accurate provider directories, and mandates independent secret-shopper surveys to check whether listed providers actually accept new patients6. Because the carve-out vendors operate under the CMO contracts, these access obligations reach them too, which means a documented pattern of failed access can support a complaint to DCH.

How to Appeal a Denial

When an administrator denies a service, the appeal usually starts with that administrator and can escalate to the state:

Free help with an appeal is available from the Georgia Legal Services Program, Atlanta Legal Aid Society, Disability Rights Georgia, and the Georgia Long-Term Care Ombudsman. For the full appeals walkthrough, see the Georgia Medicaid appeals and fair hearings guide.

Learn More

Find personalized help figuring out which company runs your Georgia Medicaid benefits at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.