MedicaidPrior AuthHigh impact
25-829 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, reducing standard prior auth decisions from 5 business days to 7 calendar days. Healthcare practices must streamline their review processes and prepare for API integration by 2027 to meet these faster turnaround requirements.
Action Required
By January 1, 2026: Medical billing teams must update prior authorization workflows to accommodate 7 calendar day turnaround for standard requests (down from 5 business days). Review and streamline internal processes, consider automation or increased staffing. Prepare data reporting systems to support public prior authorization metrics. Update delegation agreements to reflect new performance standards. By January 1, 2027: Implement prior authorization API systems for automated submission and tracking.