Five things to know:
1. Starting Oct. 1, 2018, beneficiaries enrolled in Arizona’s Medicaid program — the Arizona Health Care Cost Containment System — transitioned to integrated physical and behavioral health coverage.
2. Subsequently, new contracts and reimbursement rates had to be negotiated between insurance companies and provider agencies. However, some providers did not receive finalized contracts until mid-January. Affected providers said delays in claims processing and inaccurate payment rates have led to confusion and financial pressure.
3. On Jan. 25, AHCCCS issued a $125,000 fine against one health plan due to the delays, according to the Arizona Daily Star. The agency said the insurer’s claim processing failures violated its contract, as it wrongly denied $868,000 worth of claims submitted by 12 providers. The sanction notice also accused the health plan of loading incorrect reimbursement rates for nearly 2,000 providers into its claims system.
4. AHCCCS spokesperson Heidi Capriotti told the publication in a written statement that “AHCCCS is listening to and addressing concerns brought forth by our members, providers and health plans in order to continue to make this transition successful.”
5. Still, some providers say they are on the brink of closure after four months of shouldering losses linked to unpaid or underpaid claims, according to the report.
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