Impartial Doctors May Aid Medicaid Appeals, With a Cost (Correct)

Requiring the use of impartial third-party doctors to review claims denials by Medicaid managed care organizations would greatly improve access to care for beneficiaries, but could further strain the nation’s Medicaid budget, policy advisers say.

The Medicaid and Chip Payment and Access Commission introduced recommendations Thursday that would allow state Medicaid programs to ferry prior authorization grievances to an impartial clinician if a beneficiary’s claims appeal is denied by an MCO, overhauling the managed care appeals process toward favoring patients rather than insurers.

The plan has worked well in 14 states currently implementing the program, with the HHS Office of ...