How Medicare TPE, UPICs, state Medicaid programs, MCOs and commercial plans run prepayment review, the records deadlines and exit rules for each, what a hold does to cash, and a week-by-week plan to pass and get off it.
42 CFR Part 2 explained for 2026: who it covers, how it differs from HIPAA, what the final rule changed, how OCR enforces it, and a compliance checklist.
How SUD chart audits work, what small samples miss, and what a 100% sweep found at one LA SUD program. Includes an audit checklist and a two-week sweep plan.
How behavioral health and SUD providers should answer a UPIC audit: the 30-day records deadline, Part 2 checks, a week-by-week plan, and extrapolation appeals.
Mental health parity in 2026: what DOL's FAB 2026-03 changes, what is enforceable today, and how BH and SUD providers can use parity in denial appeals.
The Texas AG is investigating Blue Cross Blue Shield of Texas over denials and prior authorization delays. What it means and what providers should do now.
RAC, UPIC, TPE, SMRC, CERT, Medicaid RAC and MFCU audits explained for behavioral health: who runs each, what triggers it, record deadlines, outcomes, appeals.
The 2024 Part 2 final rule is now enforceable. What a compliant SUD consent must include, what single consent changed, and the documentation that keeps you covered.
The DOJ's new National Fraud Enforcement Division is using data analytics to flag outlier providers. Here is what behavioral health and SUD programs should know and do.
EHR audit tools for compliance, privacy and HIM teams, compared by audit job: access monitoring, chart and documentation audit, coding and billing audit, and payer audit response. Seven tools with a Best for line each, plus what network accuracy and adequacy audits mean for health plans.
The best 42 CFR Part 2-compliant software for substance use disorder programs in 2026, from AI compliance layers to SUD EHRs, and how to choose.
