Regulations & Laws
CMS Prior Authorization Rule: 2026 Deadlines Payers Must Meet
Under the CMS Interoperability and Prior Authorization final rule, impacted payers face new decision timeframes starting in 2026. Here is what it means for your practice.
The rule in brief
CMS's Interoperability and Prior Authorization final rule requires impacted payers, including Medicare Advantage, Medicaid, CHIP, and qualified health plan issuers on the federal exchanges, to meet faster decision timeframes beginning in 2026: generally 72 hours for expedited and seven calendar days for standard requests.
Payers must also give a specific reason when they deny a request.
What practices should do
Track authorization turnaround by payer so you can document delays.
Use denial reasons to fix documentation gaps quickly.
Keep a payer-specific authorization matrix updated for your top procedures.
How we help
Our billing team manages authorizations end to end and escalates when payers miss required timeframes.
This article is for general information and is not legal advice. Rules change often — confirm current requirements with CMS, your payers, or counsel.