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Prior Approval Changes Effective January 1, 2027
Act
by Dec 1, 2026
Effective date
Jan 1, 2027
Identified
Jun 30, 2026
Summary
New York State Medicaid is implementing federally-mandated prior authorization timeline changes effective January 1, 2027. Standard PA requests must be adjudicated within 7 days (previously 21 days), expedited requests within 72 hours, with an optional 14-day extension if additional information is needed. Failure to provide requested documentation within these timeframes will result in PA denial.
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What to do
by Dec 1, 2026 · 7 steps
01Billing team must update PA submission and tracking procedures to comply with new 7-day and 72-hour timelines for NYS Medicaid.
02Implement system alerts to track PA request submission dates and required decision dates.
03Update PA templates and submission checklists to ensure all necessary documentation is included upfront to avoid 14-day extension delays.
04Establish expedited PA protocols for emergency cases with 72-hour turnaround.
05Enroll providers in ePACES and eMedNY eXchange if not already enrolled to enable real-time PA submissions and tracking.
06Train billing and clinical staff on new timelines and consequences (PAs not decided within timeframes or unsupported by documentation will be denied, impacting claim payment).
07Contact eMedNY at (800) 343-9000 for billing questions or OHIPMedPA@health.ny.gov for policy clarifications.
Original notice
Prior Approval Changes Effective January 1, 2027
health.ny.gov · Always check the source before changing claims.