Becker's Healthcare September 29, 2023
Rylee Wilson

Lawmakers are launching an investigation into the largest Medicaid managed care organizations over prior authorization denial rates.

On Sept. 28, Sen. Ron Wyden, chair of the Senate Committee on Finance, and Rep. Frank Pallone, ranking member of the House Committee on Energy and Commerce, sent letters to the seven largest Medicaid managed care providers, requesting they submit information on the rate of appeals and denials in their plans, and information on any AI algorithms used in the prior authorization process.

An HHS Office of Inspector General report found the seven largest Medicaid MCO parent companies deny around 1 in 8 prior...

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Topics: Congress / White House, Govt Agencies, Insurance, Medicaid, Payer, Provider
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