Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Providers say prior-authorization and coding changes left legitimate programs unpaid; Access officials point to fraud response
Summary
Providers including The Haven and trade groups told senators that October 2024 coding and prior-authorization changes, and delayed payments, forced closures and unpaid claims; Access officials said many claims are still paid (84% approval in prepayment review) while acknowledging timeliness and staffing problems and pledging more technical assistance and data.
Providers and provider groups testified that policy changes and prepayment-review processes implemented after the fraud revelations have disrupted cash flow for legitimate behavioral-health providers.
"Every day that funding is withheld from legitimate providers like the Haven, more people lose access to life-saving treatment," Amy Graves, CEO of The Haven in Tucson, told the committee, saying the organization is owed about $375,000 for…
Already have an account? Log in
Subscribe to keep reading
Unlock the rest of this article — and every article on Citizen Portal.
- Unlimited articles
- AI-powered breakdowns of topics, speakers, decisions, and budgets
- Instant alerts when your location has a new meeting
- Follow topics and more locations
- 1,000 AI Insights / month, plus AI Chat
