MedicaidPrior AuthHigh impact
Modernizing Prior Authorization and Interoperability Requirements Effective 2026–2027
L.A. Care Health Plan·CA·Prior Authorization
Effective date
Jan 1, 2026
We identified it
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.
Action Required
By January 1, 2026: Billing team must prepare for new PA processing timeframes (7 days standard, 72 hours expedited) and ensure continuity of care during PA reviews. By March 31, 2026: Review L.A. Care's publicly posted PA metrics for benchmarking. By January 1, 2027: Assess practice's EHR FHIR interoperability capabilities for electronic PA submissions and prepare for real-time PA decision integration. Continue using L.A. Care Provider Portal for Service Authorization Requests (SARs) and contact network account manager for interoperability discussions.