AHCCCS Releases Updated Provider Payment Suspension Fact Sheet with New Resources
PHOENIX – AHCCCS updated the Provider Payment Suspension Fact Sheet on Aug. 23, 2023 to provide new information and resources about its efforts to stop fraudulent behavioral health billing and to protect members in tribal communities who’ve been targeted.
Additional system-wide improvements to the Medicaid claims payment system include:
Implemented emergency rules to enhance and expand AHCCCS authority to exclude providers affiliated with bad actors,
Requiring behavioral health providers to submit additional assessment, treatment plan, and medical records documentation with their claims,
Requiring fee-for-service providers billing more than 2 units of hourly codes or 4 units of 15-minutes codes on a single date of service, to provide additional documentation.
Additional changes to the AHCCCS provider enrollment process include:
Revision of the Provider Participation Agreement (PPA) to explicitly require that if a provider stops providing services to AHCCCS members during an ongoing investigation, they must help the member transition to a new provider for treatment. Similarly, they are required to provide to AHCCCS a member census and, upon request, any other information needed to assist in care coordination. If they do not comply, AHCCCS has the right to file an injunction to require the provider to comply with the PPA.
Additional changes to the AHCCCS member enrollment process include:
Only Native American/Alaskan Native individuals are eligible to choose AHCCCS’ American Indian Health Program (AIHP) as their health plan; in order to ensure program integrity of the AIHP selection, AHCCCS is no longer accepting changes from an Managed Care Organization (MCO) to AIHP over the phone. A change requires use of the AIHP change request form.
Anyone can report suspicion of provider or member fraud using the AHCCCS Report Fraud web page or by calling 602-417-4045 or, outside of Arizona, 888-ITS-NOT-OK (888-487-6686).
Any AHCCCS member who needs help because of a sober living home closure can call 2-1-1 (press option 7).