OIG Audit Finds Pennsylvania Behavioral Health MCO Failed To Meet Prior Authorization Requirements

Community Behavioral Health (CBH), a Pennsylvania behavioral health Medicaid managed care organization (BH-MCO), did not comply with all federal and state requirements when denying behavioral health service requests requiring prior authorization in 2023, according to a recent audit by the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services. The audit reviewed a random sample of 100 denied prior authorization requests and found that none of the sampled denials met all applicable procedural requirements for issuing prior authorization denials.

According to the OIG report, CBH was selected for audit because it had the . . .