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Amerigroup Iowa's Prior Authorization and Appeal Processes Were Effective, but Improvements Can Be Made

Submitting OIG: 
Department of Health & Human Services OIG
Date Issued: 
Wednesday, September 13, 2023
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-07-22-07007
Component, if applicable: 
Centers for Medicare & Medicaid Services
Centers for Medicare and Medicaid Services
External entity, if applicable: 
Amerigroup Iowa, Inc.
Location(s): 
IA,
United States
Type of Report: 
Audit
Questioned Costs: 
$0
Funds for Better Use: 
$0
Number of Recommendations: 
2
Report updated under NDAA 5274: 
No
View Document: 
AttachmentSize
PDF icon 72207007.pdf1.55 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
23-A-07-116.01 Open No
We recommend that Amerigroup Iowa, Inc., coordinate with the State agency to improve its prior authorization and appeal processes to ensure that members receive correct information regarding prior authorizations, the appeal process, and State fair hearing rights, procedures, and timeframes.
23-A-07-116.02 Open No
We recommend that Amerigroup Iowa, Inc., coordinate with the State agency to review and update its prior authorization process to improve communication with providers and thereby avoid or minimize delays that prevent members from receiving needed medical services.
Displaying 2 of 2 Recommendations