Para cumplir con la norma final de interoperabilidad y autorizaciones previas de los CMS, Sentara Health Plans debe presentar un informe anual de las métricas de autorizaciones previas combinadas en nuestro sitio web. En concreto, esto incluye una lista de todos los artículos y servicios médicos (excluidos los fármacos) que requieren autorización previa, así como datos sobre solicitudes de autorización previa para esos artículos y servicios (p. ej., aprobaciones, denegaciones, etc.) durante el año calendario anterior. Informar al público de estas métricas promueve la transparencia y la responsabilidad, ayuda a los pacientes a comprender los procesos de autorización previa y permite a los proveedores evaluar el rendimiento del pagador. Además, las métricas se pueden utilizar para comparar planes, programas y pagadores. Si tiene alguna pregunta sobre los datos que aparecen a continuación, contáctenos.
Puede encontrar una lista de artículos y servicios médicos para los que necesitamos autorización previa (excepto fármacos) aquí: https://pal.sentarahealthplans.com/.
Antes del 1 de enero de 2026, Sentara Health Plans debía enviar las decisiones de autorización previa en los siguientes plazos:
- 72 horas para las solicitudes aceleradas (urgentes)
- 14 días calendario para las solicitudes estándar (no urgentes)
A partir del 1 de enero de 2026, la norma final de interoperabilidad y autorizaciones previas de los CMS exige que Sentara Health Plans envíe las decisiones de autorización previa dentro de:
- 72 horas para las solicitudes aceleradas (urgentes)
- 7 días calendario para las solicitudes estándar (no urgentes)
Medicaid
Reporting Period: January 1, 2025 – December 31, 2025
(*Data reported is current as of 1/30/2026)
Total standard authorization request decisions: 228,807
Total expedited authorization request decisions: 121,645
| Decision Type | Occurrence | Total Requests | Percentage |
| Decision Type Standard authorization request approved | Occurrence 183,059 | Total Requests228,807 | Percentage80.01% |
| Decision Type Standard authorization request denied | Occurrence 45,748 | Total Requests228,807 | Percentage19.99% |
| Decision Type Standard authorization request approved after appeal review | Occurrence 443 | Total Requests 1,363 | Percentage 32.50% |
| Decision Type Expedited authorization request approved | Occurrence 105,748 | Total Requests121,645 | Percentage86.93% |
| Decision Type Expedited authorization request denied | Occurrence 15,897 | Total Requests121,645 | Percentage13.07% |
| Decision TypeStandard and expedited authorizations approved following extended review | Occurrence 0 | Total Requests350,452 | Percentage0.00% |
| Authorization turnaround time | Mean (average) time | Median (middle) time |
| Authorization turnaround time Standard authorization turnaround time | Mean (average) time 6.4 days | Median (middle) time 5.0 days |
| Authorization turnaround time Expedited authorization turnaround time | Mean (average) time 26.2 hours | Median (middle) time 22.4 hours |
Commercial
| Decision Type | Decision Occurrences | Total Standard PA Decisions | Percentage of Standard PA Decisions |
| Decision TypeStandard authorization request approved | Decision Occurrences108,452 | Total Standard PA Decisions120,290 | Percentage of Standard PA Decisions90.16% |
| Decision TypeStandard authorization request denied | Decision Occurrences11,838 | Total Standard PA Decisions120,290 | Percentage of Standard PA Decisions9.84% |
| Decision TypeExpedited request approved | Decision Occurrences16,169 | Total Standard PA Decisions16,746 | Percentage of Standard PA Decisions96.55% |
| Decision TypeExpedited request denied | Decision Occurrences577 | Total Standard PA Decisions16,746 | Percentage of Standard PA Decisions3.45% |
| Decision TypeRequest approved following extended review | Decision Occurrences0 | Total Standard PA Decisions137,036 | Percentage of Standard PA Decisions0.00% |
| Decision TypeStandard request approved following appeal review | Decision Occurrences56 | Total Standard PA Decisions127 | Percentage of Standard PA Decisions44.09% |
| PA Turnaround time | Mean (average) TAT | Median (middle) TAT |
| PA Turnaround timeStandard PA Request TAT | Mean (average) TAT4.0 days | Median (middle) TAT2.0 days |
| PA Turnaround timeExpedited PA Request TAT | Mean (average) TAT20.1 hours | Median (middle) TAT1.0 hours |
Medicare
| Decision Type | Decision Occurrences | Total Standard PA Decisions | Percentage of Standard PA Decisions |
| Decision TypeStandard authorization request approved | Decision Occurrences46,995 | Total Standard PA Decisions49,506 | Percentage of Standard PA Decisions94.93% |
| Decision TypeStandard authorization request denied | Decision Occurrences2,511 | Total Standard PA Decisions49,506 | Percentage of Standard PA Decisions5.07% |
| Decision TypeExpedited request approved | Decision Occurrences5,371 | Total Standard PA Decisions5,527 | Percentage of Standard PA Decisions97.18% |
| Decision TypeExpedited request denied | Decision Occurrences156 | Total Standard PA Decisions5,527 | Percentage of Standard PA Decisions2.82% |
| Decision TypeRequest approved following extended review | Decision Occurrences0 | Total Standard PA Decisions55,033 | Percentage of Standard PA Decisions0.00% |
| Decision TypeStandard request approved following appeal review | Decision Occurrences134 | Total Standard PA Decisions127 | Percentage of Standard PA Decisions0% |
| PA Turnaround time | Mean (average) TAT | Median (middle) TAT |
| PA Turnaround timeStandard PA Request TAT | Mean (average) TAT4.8 days | Median (middle) TAT2.0 days |
| PA Turnaround timeExpedited PA Request TAT | Mean (average) TAT22.0 hours | Median (middle) TAT4.0 hours |