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.

The Provider Payment Suspensions Fact Sheet includes additional provider enrollment and claims payment system changes made since June 14, 2023, a flow chart of the Credible Allegation of Fraud payment suspension process, and a flier about the 4 Steps to Review Provider Credibility.

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.