Organization Detail
Virginia Department of Medical Assistance Services
1 plan across 1 state · Medicaid FFS
Virginia Department of Medical Assistance Services reported prior authorization metrics for 1 Medicaid FFS plan across 1 state under CMS rule CMS-0057-F for calendar year 2025. Across those plans, Virginia Department of Medical Assistance Services processed 724,465 standard prior authorization requests. The average standard prior authorization denial rate was 24.4%, above the national average of 11.8%. When patients or providers appealed denied prior authorizations, 8.6% of appeals were overturned on average. Standard prior authorization decisions took an average of 5.2 days.
24.4%
Virginia Department of Medical Assistance Services Denial Rate
standard, avg across 1 plans
11.8%
National Average
all reporting plans
+12.6%
vs. National
above average
VA1 plan
| Plan | Requests | Approved | Denied | Appr % | Denial % ▼ | Appeals | Overturn % | Denied Appeal % | Appr Ext % | Denied Ext % | Mean Days | Med Days |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Virginia DMAS Medicaid FFS (CY 2025)Medicaid FFS | 724,465 | 547,433 | 177,032 | 75.6% | 24.4% | 11,298 | 8.6% | 91.4% | 2.4% | 97.6% | 5.2 | — |