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Recommendation Details
Text of Recommendation
CMS should Require States to implement automatic external medical reviews of upheld MCO prior authorization denials.
Recommendation Number
23-E-09-029.04
Recommendation Status
Open
Significant Recommendation
No
Recommendation Questioned Costs
$0
Recommendation Funds for Better Use
$0
Associated Report Details
Submitting OIG
Department of Health & Human Services OIG
Linked Report
High Rates of Prior Authorization Denials by Some Plans and Limited State Oversight Raise Concerns About Access to Care in Medicaid Managed Care