Becker's Healthcare July 19, 2023
HHS’ Office of Inspector General raised concerns about the rate of prior authorization denials in Medicaid managed care and a lack of state oversight of these denials in an audit published July 17.
The OIG audited seven parent companies with the highest number of enrollees, accounting for 115 MCOs across 37 states.
On average, Medicaid managed care organizations denied around 1 in 8 prior authorization requests, according to the audit. Of the 115 MCOs the OIG audited, 12 had prior authorization denial rates greater than 25 percent.
The OIG interviewed 37 state Medicaid directors as part of the audit and found most states said they did not routinely review the prior...
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