Filing · f0398
The Health Plan - West Virginia Medicaid
The Health Plan · Medicaid Managed Care · WV · CY2025
In 2025 this plan received 48,894 standard prior authorization requests and denied 17.1% of them. The median for Medicaid Managed Care plans of comparable size is 13.2%.
Standard denial rate
17.1%
48,894 standard requests, 8,366 denied.
52.7% of appealed denials were overturned.
Requests and outcomes
| Total | Approved | Denied | Denial rate | |
|---|---|---|---|---|
| Standard | 48,894 | 40,528 | 8,366 | 17.1% |
| Expedited | 500 | 431 | 69 | 13.8% |
| Extended review, approved | 71 | |||
Appeals of standard denials
| Appeals filed | 74 |
| Denials overturned | 39 |
| Overturn rate | 52.7% |
Turnaround
| Mean | Median | |
|---|---|---|
| Standard | 1.0 d | 0.0 d |
| Expedited | 24.0 h | 24.0 h |