Traditional MedicarePrior AuthHigh impact
25-828 Prepare for New Prior Authorization Timelines
Health Net·CA·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
CMS is implementing new prior authorization timelines effective January 1, 2026, requiring standard requests to be processed within 7 calendar days (down from 14 days for Medicare and 5 business days for Medi-Cal). Healthcare practices must prepare their review systems and data reporting to meet these accelerated deadlines.
Action Required
Before January 1, 2026: Billing and utilization management teams must streamline internal prior authorization review processes to meet new 7 calendar day standard timelines (down from current 14 calendar days for Medicare and 5 business days for Medi-Cal). Update delegation agreements, implement automation or increase staffing as needed, and ensure detailed data reporting systems are ready for public metrics reporting. Urgent requests remain at 72 hours.