Vaya Health must approve some services as “medically necessary” before you receive them. This is called prior authorization. For State-funded services, Vaya also considers the availability of non-Medicaid funding. To request approval of services that require prior authorization, your health care provider will submit a request to Vaya on your behalf.
To learn about which services require prior authorization and the approval process, refer to your Vaya Member Handbook or Recipient Handbook. Information for providers is available on the Prior Authorization y Authorization Guidelines pages of our Provider Central website.
Publicly reporting this information promotes transparency and accountability, helps members and recipients understand prior authorization processes, and enables providers to evaluate payor performance. In addition, this data can be used to compare plans, programs, and payors.
The Centers for Medicare & Medicaid Services requires Vaya to provide data on our website by March 31 of each year about how many prior authorizations for services were submitted and approved or denied in the prior year. This reporting is part of CMS Interoperability and Prior Authorization Final Rule CMS-0057-F.
Tailored Plan Data
Calendar Year 2025*
Total requests received
329,016
Standard requests
Approved:
Denied:
Average turnaround time (Days):
Median turnaround time (Days):
Denied requests approved after appeal:
96.6%
3.4%
10.17
10
29.0%
Expedited requests
Approved:
Denied:
Average turnaround time (Hours):
Median turnaround time (Hours):
97.8%
2.2%
24
4
Percentage of requests extended for additional information that were approved:
Total percentage extended:
Total percentage approved:
0.2%
75.7%
Medicaid Direct Data
Calendar Year 2025*
Total requests received
5,981
Standard requests
Approved:
Denied:
Average turnaround time (Days):
Median turnaround time (Days):
Denied requests approved after appeal:
91.1%
8.9%
7.17
7
34.0%
Expedited requests
Approved:
Denied:
Average turnaround time (Hours):
Median turnaround time (Hours):
99.9%
0.1%
9
4
Percentage of requests extended for additional information that were approved:
Total percentage extended:
Total percentage approved:
0.06%
60.0%
* Excludes data on drugs
