MedicaidPrior AuthMedium impact
Provider Letter 2025-22: RE: Prior Authorization Timeliness - Alignment with CMS Interoperability and Prior Authorization Rule (CMS-0057-F)
Oklahoma SoonerCare·OK·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Oklahoma Medicaid (SoonerCare) is implementing new prior authorization processing timelines effective January 1, 2026, to comply with CMS regulations. Standard prior authorizations must be processed within 7 calendar days (with some exceptions allowing 14 or 21 days), while expedited/urgent prior authorizations must be processed within 72 hours.
Action Required
Before January 1, 2026: Billing team should update prior authorization workflows to account for new SoonerCare processing timelines. Ensure staff understand that expedited PAs (acute inpatient behavioral health, clinical trials) will be processed within 72 hours, standard PAs within 7 days, and certain complex services (out-of-state, medical transportation, private duty nursing, etc.) may take 14-21 days. Monitor authorization status more closely and follow up if timeframes are exceeded.