Prior authorization denial rates for 7 payers’ Medicaid MCOs

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 enrollees are not being inappropriately denied care,” the OIG wrote in the report. 

The watchdog recommended several steps CMS could take to improve state oversight of Medicaid prior authorization in the report. 

Here are the overall denial rates for seven Medicaid MCOs in 2019: 

1. Molina Healthcare
   Overall denial rate: 17.7 percent

2. CareSource
   Overall denial rate: 15.4 percent 

3. UnitedHealthcare
   Overall denial rate: 13.6 percent

4. Anthem (Elevance Health)
   Overall denial rate: 12.9 percent

5. Centene
   Overall denial rate: 12.2 percent

6. Aetna
   Overall denial rate: 12.1 percent 

7. AmeriHealth Caritas
   Overall denial rate: 6.1 percent 

See the full report here. 

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