{"id":56986,"date":"2026-03-30T16:36:05","date_gmt":"2026-03-30T20:36:05","guid":{"rendered":"https:\/\/www.vayahealth.com\/?page_id=56986"},"modified":"2026-04-14T14:28:42","modified_gmt":"2026-04-14T18:28:42","slug":"prior-authorization-data","status":"publish","type":"page","link":"https:\/\/www.vayahealth.com\/es\/about\/transparency\/prior-authorization-data\/","title":{"rendered":"Autorizaci\u00f3n previa de datos"},"content":{"rendered":"
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Vaya Health debe aprobar algunos servicios como \u201cm\u00e9dicamente necesarios\u201d antes de que los reciba. Esto se llama autorizaci\u00f3n previa. Para los servicios financiados por el estado, Vaya tambi\u00e9n considera la disponibilidad de financiaci\u00f3n no proporcionada por Medicaid. Para solicitar la aprobaci\u00f3n de servicios que requieren autorizaci\u00f3n previa, su proveedor de atenci\u00f3n m\u00e9dica enviar\u00e1 una solicitud a Vaya en su nombre.<\/p>\n\n\n\n

Para obtener informaci\u00f3n sobre qu\u00e9 servicios requieren autorizaci\u00f3n previa y el proceso de aprobaci\u00f3n, consulte su Vaya Manual para Miembros o Manual para Receptores. La informaci\u00f3n para proveedores est\u00e1 disponible en Autorizaci\u00f3n previa<\/a> y Directrices de Autorizaci\u00f3n<\/a> p\u00e1ginas de nuestro sitio web de Proveedor Central.<\/p>\n\n\n\n

Informar p\u00fablicamente esta informaci\u00f3n promueve la transparencia y la rendici\u00f3n de cuentas, ayuda a los miembros y beneficiarios a comprender los procesos de autorizaci\u00f3n previa y permite a los proveedores evaluar el desempe\u00f1o de los pagadores. Adem\u00e1s, estos datos pueden utilizarse para comparar planes, programas y pagadores.<\/p>\n\n\n\n

Los Centros de Servicios de Medicare y Medicaid requieren que Vaya proporcione datos en nuestro sitio web antes del 31 de marzo de cada a\u00f1o sobre cu\u00e1ntas autorizaciones previas de servicios se presentaron y aprobaron o denegaron el a\u00f1o anterior. Este informe forma parte de la Regla final de interoperabilidad y autorizaci\u00f3n previa de CMS CMS-0057-F.<\/em><\/p>\n<\/div>\n\n\n\n

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Plan de Datos Personalizado<\/h3>\n\n\n\n

A\u00f1o Natural 2025*<\/h5>\n<\/div>\n<\/div>\n\n\n\n
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Solicitudes totales recibidas<\/p>\n<\/div>\n\n\n\n

<\/div>\n\n\n\n
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329,016<\/p>\n<\/div>\n<\/div>\n\n\n\n

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Solicitudes est\u00e1ndar<\/p>\n<\/div>\n\n\n\n

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Aprobado:<\/p>\n\n\n\n

Denegado:<\/p>\n\n\n\n

Tiempo promedio de respuesta (D\u00edas):<\/p>\n\n\n\n

Tiempo medio de respuesta (D\u00edas):<\/p>\n\n\n\n

Solicitudes denegadas aprobadas despu\u00e9s de apelaci\u00f3n:<\/p>\n<\/div>\n\n\n\n

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96.6%<\/p>\n\n\n\n

3.4%<\/p>\n\n\n\n

5.55<\/p>\n\n\n\n

4.00<\/p>\n\n\n\n

29.0%<\/p>\n<\/div>\n<\/div>\n\n\n\n

\n
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Solicitudes urgentes<\/p>\n<\/div>\n\n\n\n

\n

Aprobado:<\/p>\n\n\n\n

Denegado:<\/p>\n\n\n\n

Tiempo de respuesta promedio (Horas):<\/p>\n\n\n\n

Tiempo de respuesta medio (horas):<\/p>\n<\/div>\n\n\n\n

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97.8%<\/p>\n\n\n\n

2.2%<\/p>\n\n\n\n

10.58<\/p>\n\n\n\n

3.62<\/p>\n<\/div>\n<\/div>\n\n\n\n

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Porcentaje de solicitudes ampliadas para informaci\u00f3n adicional que fueron aprobadas:<\/p>\n<\/div>\n\n\n\n

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Porcentaje total extendido:<\/p>\n\n\n\n

Porcentaje total aprobado:<\/p>\n<\/div>\n\n\n\n

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0.2%<\/p>\n\n\n\n

75.7%<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n

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Datos Directos de Medicaid<\/h3>\n\n\n\n

A\u00f1o Natural 2025*<\/h5>\n<\/div>\n<\/div>\n\n\n\n
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Solicitudes totales recibidas<\/p>\n<\/div>\n\n\n\n

<\/div>\n\n\n\n
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5,981<\/p>\n<\/div>\n<\/div>\n\n\n\n

\n
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Solicitudes est\u00e1ndar<\/p>\n<\/div>\n\n\n\n

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Aprobado:<\/p>\n\n\n\n

Denegado:<\/p>\n\n\n\n

Tiempo promedio de respuesta (D\u00edas):<\/p>\n\n\n\n

Tiempo medio de respuesta (D\u00edas):<\/p>\n\n\n\n

Solicitudes denegadas aprobadas despu\u00e9s de apelaci\u00f3n:<\/p>\n<\/div>\n\n\n\n

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91.1%<\/p>\n\n\n\n

8.9%<\/p>\n\n\n\n

7.03<\/p>\n\n\n\n

7.01<\/p>\n\n\n\n

34.0%<\/p>\n<\/div>\n<\/div>\n\n\n\n

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Solicitudes urgentes<\/p>\n<\/div>\n\n\n\n

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Aprobado:<\/p>\n\n\n\n

Denegado:<\/p>\n\n\n\n

Tiempo de respuesta promedio (Horas):<\/p>\n\n\n\n

Tiempo de respuesta medio (horas):<\/p>\n<\/div>\n\n\n\n

\n

99.9%<\/p>\n\n\n\n

0.1%<\/p>\n\n\n\n

9.10<\/p>\n\n\n\n

3.82<\/p>\n<\/div>\n<\/div>\n\n\n\n

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Porcentaje de solicitudes ampliadas para informaci\u00f3n adicional que fueron aprobadas:<\/p>\n<\/div>\n\n\n\n

\n

Porcentaje total extendido:<\/p>\n\n\n\n

Porcentaje total aprobado:<\/p>\n<\/div>\n\n\n\n

\n

0.06%<\/p>\n\n\n\n

60.0%<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\n\n

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* Excluye datos sobre drogas<\/em><\/p>\n<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"

Vaya Health must approve some services as \u201cmedically necessary\u201d before you receive them. This is called prior authorization. For State-funded services, Vaya also considers the availability of non-Medicaid funding. To […]<\/p>\n","protected":false},"author":62,"featured_media":0,"parent":9333,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"breadcrumbs","meta":{"_tec_requires_first_save":true,"_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"_EventAllDay":false,"_EventTimezone":"","_EventStartDate":"","_EventEndDate":"","_EventStartDateUTC":"","_EventEndDateUTC":"","_EventShowMap":false,"_EventShowMapLink":false,"_EventURL":"","_EventCost":"","_EventCostDescription":"","_EventCurrencySymbol":"","_EventCurrencyCode":"","_EventCurrencyPosition":"","_EventDateTimeSeparator":"","_EventTimeRangeSeparator":"","_EventOrganizerID":[],"_EventVenueID":[],"_OrganizerEmail":"","_OrganizerPhone":"","_OrganizerWebsite":"","_VenueAddress":"","_VenueCity":"","_VenueCountry":"","_VenueProvince":"","_VenueState":"","_VenueZip":"","_VenuePhone":"","_VenueURL":"","_VenueStateProvince":"","_VenueLat":"","_VenueLng":"","_VenueShowMap":false,"_VenueShowMapLink":false,"_tribe_blocks_recurrence_rules":"","_tribe_blocks_recurrence_description":"","_tribe_blocks_recurrence_exclusions":"","banner-text":"","banner-text-color":"","button-text":"","button-text-color":"","button-link":"","has-button-icon":"","background-color":"","has-background-icon":"","background-icon-color":"","second-featured-image":"","footnotes":""},"class_list":["post-56986","page","type-page","status-publish","hentry"],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/pages\/56986","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/users\/62"}],"replies":[{"embeddable":true,"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/comments?post=56986"}],"version-history":[{"count":3,"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/pages\/56986\/revisions"}],"predecessor-version":[{"id":57319,"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/pages\/56986\/revisions\/57319"}],"up":[{"embeddable":true,"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/pages\/9333"}],"wp:attachment":[{"href":"https:\/\/www.vayahealth.com\/es\/wp-json\/wp\/v2\/media?parent=56986"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}