Here's what's changing, what it means for your practice, and what to do now.
What is changing with prior authorization?
A federal rule (the CMS Interoperability and Prior Authorization Rule) is changing how insurers handle prior approvals, in two steps:
- Since January 1, 2026these plans must answer urgent requests within 72 hours and standard requests within 7 days. They must also give a specific reason for every denial.
- From January 1, 2027they must accept and answer prior approval requests electronically, through systems that connect to your EHR.
This covers Medicare Advantage plans, Medicaid and CHIP, and ACA marketplace plans on the federal exchange. It does not cover employer plans or traditional Medicare.
This week, CMS also announced that Amazon, Google, Meta, Oracle and Axon have joined its pledge to make prior approvals faster and simpler by 2027.
How this affects your practice
Faster answers, if your systems can send requests electronically.
Clearer denials. Every denial must explain why, which makes appeals easier to win.
Practices using fax and phone will fall behind. Electronic requests will be answered first and more smoothly.
Two systems for a while. You'll still need fax or phone for plans not covered by the rule.
What to do now: 5 simple steps
How to turn this into an opportunity
Get paid sooner.
Faster approvals mean faster scheduling and faster payment.
Win more appeals.
Specific denial reasons show you exactly what to send.
Use the data.
Plans must publish their approval and denial rates. Use those numbers when deciding which plans to join or when negotiating contracts.
Save staff time.
Less time on hold means more time for patients and collections.
Key dates
| Date | What happens |
|---|---|
| January 1, 2026 | 72-hour and 7-day response limits and denial reasons already apply |
| Now | Talk to your EHR vendor and start tracking requests |
| January 1, 2027 | Electronic prior approval systems required for covered plans |
The bottom line
Talk to your EHR vendor this month. Practices that go electronic will get faster approvals, fewer write-offs and happier staff.
Frequently asked questions
What is electronic prior authorization?
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It means sending prior approval requests and getting answers through your EHR or billing software, instead of by fax or phone. It is faster and easier to track.
Which insurance plans must follow the new rule?
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Medicare Advantage plans, Medicaid and CHIP, and ACA marketplace plans on the federal exchange. Employer plans and traditional Medicare are not covered.
How fast must insurers answer prior approval requests?
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Within 72 hours for urgent requests and 7 days for standard requests. They must also give a specific reason for every denial.
What if an insurer misses the deadline?
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Write down the dates, contact the plan, and file a complaint if it keeps happening. For Medicare Advantage plans, complaints can also go to Medicare at 1-800-MEDICARE.
Feeling overwhelmed? HealthRescue Partners can help
If you're not sure your practice is ready for electronic prior approvals, HealthRescue Partners can help. We can:
- Explain the new rules in plain terms
- Give you a simple readiness checklist and request-tracking template
- Help you set up a smoother prior approval process
Sources
- CMS announces five organizations sign prior authorization pledgeAmerican Hospital Association, Oct 21, 2026
- Insurers have cut prior auth requirements by 11%Becker's Payer Issues
This article is general information, not legal or billing advice.