Becker's Healthcare July 20, 2023
Molina Healthcare has the highest overall prior authorization denial rates of the seven largest Medicaid managed care organizations, according to an audit from HHS’ Office of Inspector General.
The audit, published July 17, examined seven parent companies with the highest number of enrollees, accounting for 115 MCOs across 37 states.
On average, Medicaid managed care plans denied 12.5 percent of prior authorization requests, but the denial rates among plans varied widely, with a low of 2 percent up to a high of 34 percent.
The variation in denial rates between managed care organizations “emphasizes the need for targeted State oversight of prior authorization denials to ensure that...
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