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L.A. Care Health PlanMedicaid · Prior Auth · Prior Authorization · CAHigh impact

Modernizing Prior Authorization and Interoperability Requirements Effective 2026–2027

Act
by Jan 1, 2026
Effective date
Jan 1, 2026
Identified
Jun 20, 2026

Summary

L.A. Care Health Plan is implementing major prior authorization and interoperability changes in two phases: 2026 requirements include faster PA decision timeframes (7 days standard, 72 hours expedited), enhanced denial transparency, and public reporting of PA metrics. 2027 requirements mandate FHIR-based electronic PA APIs and real-time decision capabilities with 80% automation goals.

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What to do

by Jan 1, 2026 · 6 steps
01Billing team must prepare for new PA processing timeframes (7 days standard, 72 hours expedited) and ensure continuity of care during PA reviews.
02By March 31, 2026: Review L.A.
03Care's publicly posted PA metrics for benchmarking.
04By January 1, 2027: Assess practice's EHR FHIR interoperability capabilities for electronic PA submissions and prepare for real-time PA decision integration.
05Continue using L.A.
06Care Provider Portal for Service Authorization Requests (SARs) and contact network account manager for interoperability discussions.

Original notice

Modernizing Prior Authorization and Interoperability Requirements Effective 2026–2027
lacare.org · Always check the source before changing claims.
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