OIG Releases Report on Medicaid Managed Care Prior Authorizations

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On July 19, the Office of Inspector General (OIG) at the US Department of Health and Human Services released a report detailing concerns about the prior authorization processes used by Medicaid Managed Care Organizations (MCOs). In the report, OIG found that: On average, the reviewed MCOs denied one out of every eight prior authorization requests […]

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Report: Improvements Needed to Prevent Medicaid Managed Care Payment Risks

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The Centers for Medicare & Medicaid (CMS) should require states to report and document the amount of overpayments by managed care organizations to providers in order to eliminate improper payments, according to a new study from the Government Accountability Office (GAO). Under this Medicaid model, states pay a set periodic amount to MCOs for each beneficiary and […]

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