Medicaid Managed Care Plans Deny 12.5% Of Prior Authorization Requests

In 2019, Medicaid managed care organizations (MCOs) denied 12.5% of the prior authorization requests analyzed by the Department of Health and Human Services (HHS) Office of the Inspector General (OIG), with individual MCO denial rates ranging from 2% to 41%. The parent companies of these MCOs, across all their Medicaid managed care plans nationwide, had denial rates ranging from 6% to 18%. Twelve MCOs that cover 2.7 million people had denial rates exceeding 25%, according to OIG's analysis.

Denial Rate Details Of 7 MCO Parent Companies

Parent Company
Lowest MCO Denial Rate
Highest MCO Denial Rate
Overall . . .