Medicare AdvantagePrior AuthHigh impact
Provider Bulletin 11-12-2025 CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) IM IE LA OC SAC SD
Molina Healthcare·CA·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
CMS is implementing new federal rules requiring API-based systems for prior authorization and patient data access, with strict new timelines for PA decisions (72 hours for urgent, 7 days for standard). Healthcare practices must prepare for technology upgrades and workflow changes as payers implement these requirements over the next two years.
Action Required
By January 1, 2026: Prepare for new prior authorization timelines - urgent requests must be decided within 72 hours, standard requests within 7 days. By January 1, 2027: Ensure billing systems can integrate with new API-based prior authorization platforms that payers will implement. Contact Molina Provider Relations representatives for specific implementation guidance and system requirements.