CMS Prior Authorization Change Summary: Effective 04/01/2026

Date: 11/07/25

On April 1, 2026, the Centers for Medicare & Medicaid Services (CMS) will implement new prior authorization (PA) response time requirements for all providers.

• Standard prior authorization requests will be completed within 7 calendar days, with a possible extension up to 14 calendar days under certain circumstances.
• Expedited/Urgent prior authorization requests will be completed within the lesser of 72 hours -OR- the current BD turnaround time. 

With shorter response times for supporting clinical information requests, all necessary clinical information should be submitted at the time of the authorizationrequest. 

Additional Information

• Complete clinicals include Diagnosis, History and Current Condition, Treatment Plan and Interventions, and Relevant Diagnostic Tests.
• Response times can be lessened if all information is submitted with the authorization request.
• Missing clinical information may lead to a denial due to inadequate supporting records.
• Submitting prior authorization requests via the secure Availity portal allows for faster review.

If you have any questions, please contact your provider relations representative or Provider Services at 1-866-595-8133.