Providers say prior-authorization and coding changes left legitimate programs unpaid; Access officials point to fraud response
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.
The full story
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.
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