Medicare AdvantagePrior AuthHigh impact
26-157 Provider Communications Posted Online and Operations Manual Updates for January 2026
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Prior authorization timelines have been updated to seven calendar days for both Medi-Cal and Medicare services effective January 1, 2026, per CMS Final Rule CMS-0057-F. Updated prior authorization forms are now available in the Provider Library, and multiple operational documents have been revised to reflect these new timeline requirements.
Action Required
Immediately: Billing and authorization staff must update prior authorization workflows to comply with new 7-calendar-day timeline for Medicare and Medi-Cal requests. Download and begin using updated inpatient and outpatient Prior Authorization forms from the Provider Library Forms and References section. Review updated Appeals, Grievances and Disputes procedures and Authorization and Referral Timelines documentation. Failure to meet 7-day timeline may result in authorization delays or denials.