MedicaidPrior AuthMedium impact
BT2025165: IHCP to comply with CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) Jan. 1, 2026
Indiana Medicaid (IHCP)·IN·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 18, 2026
Summary
Indiana Medicaid (IHCP) will comply with new CMS rules for prior authorization decisions starting January 1, 2026. Standard prior auth decisions must still be made within 7 days (with possible 7-day extension), but urgent/expedited requests must be decided within 72 hours with no extensions allowed.
Action Required
By January 1, 2026: Billing team must update prior authorization workflows for Indiana Medicaid patients. Ensure urgent/expedited PA requests are clearly flagged as they will require 72-hour decisions with no extensions. Monitor email communications from Acentra Health for specific implementation guidance in the coming weeks.