Filing · f0392
Sentara Health Plans - Medicaid (Cardinal Care)
Sentara Health · Medicaid Managed Care · VA · CY2025
In 2025 this plan received 228,807 standard prior authorization requests and denied 20.0% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
20.0%
228,807 standard requests, 45,748 denied.
32.5% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 228,807 | 183,059 | 45,748 | 20.0% |
| Expedited | 121,645 | 105,748 | 15,897 | 13.1% |
| Extended review, approved | 0 | |||
Appeals of standard denials
| Appeals filed | 1,363 |
| Denials overturned | 443 |
| Overturn rate | 32.5% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 6.4 d | 5.0 d |
| Expedited | 26.2 h | 22.4 h |