D-SNP prior auth denial rates twice as high as all Medicare Advantage

Eileen Cook June 7, 2024June 7, 2024 CMS, D-SNP Prior Authorization Denial, Dual Eligible, Medicaid, Medicare Advantage, Medicare Part D, Older Adults

(By Jakob Emerson for Becker’s Hospital Review)

Dual-eligible special needs plan enrollees are twice as likely to have prior authorization requests denied compared to all other Medicare Advantage members, according to KFF.

According to the analysis, D-SNP carriers received nearly 670,000 prior authorization requests in 2021, which saw a 12% denial rate. The same year, all Medicare Advantage plans (which includes D-SNPs), saw a prior authorization denial rate of 6%. Continue reading here…

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