All PlansPrior AuthHigh impact
Provider Bulletin 09-15-2025 UM TAT and PA CMS 0057 Interoperability and Prior Authorization Rule IM IE LA OC SAC SD
Molina Healthcare·CA·Prior Authorization
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Molina Healthcare of California is implementing new prior authorization turnaround time requirements effective January 1, 2026, as part of CMS-0057 Interoperability Rule. Urgent prior auth requests must be completed within 72 hours and standard requests within 7 calendar days, with new APIs and public performance dashboards starting March 31, 2026.
Action Required
By January 1, 2026: Review and update prior authorization workflows to ensure all required clinical information is included with each request to avoid delays under new turnaround times (72 hours for urgent, 7 days for standard). Assign a staff lead to stay updated on CMS interoperability requirements and attend Molina education sessions. Before March 31, 2026: Review internal metrics to prepare for public performance dashboards. Regularly verify provider directory and clinical documentation accuracy to reduce delays and denials.