MedicaidPrior AuthHigh impact
25-830 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, shortening standard PA decisions from 5 business days to 7 calendar days, while urgent requests remain at 72 hours. This affects Medi-Cal providers in Imperial County and requires updated review systems and data reporting capabilities.
Action Required
By January 1, 2026: Billing and utilization management teams must update internal review processes to meet new 7 calendar day timeline for standard prior authorization requests (shortened from 5 business days). Streamline workflows through automation or increased staffing. Ensure data reporting systems can provide detailed PA metrics to support mandatory public reporting. Review and update delegation agreements to reflect new performance standards and compliance monitoring requirements.