Medicare AdvantagePrior AuthHigh impact
Effective Sept. 1, authorization will no longer be required for Medicare inpatient acute medical admissions
Priority Health·Prior Authorization
Effective date
Sep 1, 2026
We identified it
Jun 24, 2026
Summary
Effective September 1, 2026, prior authorization will no longer be required for Medicare inpatient acute medical admissions (excluding behavioral health cases). Instead, Priority Health will implement a post-admission claim review process conducted by medical directors for selected cases, focusing on shorter lengths of stay.
Action Required
Before September 1, 2026: Billing team must update workflows to stop submitting prior authorization requests for Medicare inpatient acute medical admissions. Update staff training to reflect that authorization is still required for behavioral health cases, ICU admissions, and scheduled Medicare inpatient cases. Ensure clinical documentation is comprehensive as claims may be subject to post-admission medical director review using InterQual guidelines.