Maryland Medicaid must annually report prior authorization metrics to comply with the Centers for Medicare & Medicaid Services Interoperability and Prior Authorization final rule. Reporting these metrics strengthens program integrity and transparency.
This annual report shows how often Maryland Medicaid approves, denies, or partially approves coverage requests for medical, dental and behavioral health services. It also tracks how quickly the state makes these decisions.
Prior authorization is an approval a healthcare provider must get before a patient receives certain treatments or services. Maryland Medicaid publishes a list of all services that require this advance approval.
The data below tracks performance across the state's fee-for-service medical program, and its
dental and
behavioral health administrative services organizations (ASOs). An ASO is a private company that manages approvals and processes claims on behalf of the state.
