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Providers say unpaid claims and alleged retaliation followed fraud crackdowns
Summary
Multiple providers and lawmakers told the committee that legitimate behavioral-health providers, particularly those serving Native American communities, experienced long payment delays, denials with shifting explanations, and actions they described as retaliatory after seeking help from Access.
Several providers and constituent statements read into the record described severe business and patient-care consequences they attribute to Access's post-fraud enforcement and claims-processing changes.
Senator Angus recounted constituent complaints about a Phoenix provider (referred to in testimony as "ACME") that said Access stopped paying tens of millions in claims and then gave shifting reasons for denials during training and vendor calls. "At the end of the meeting, Acme was told that all of their claims more than 800 were missing a required signature and would have to be resubmitted again,"…
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