CMS Finalizes Prior Authorization Requirements for Medicare Advantage Plans

Plans must now respond to urgent prior authorization requests within 72 hours and standard requests within 7 days. Every billing team touching Medicare Advantage needs to update their workflow now.

CMS has finalized sweeping prior authorization reforms for Medicare Advantage plans effective 2026. The rule sets binding response time standards MA plans have never faced before — and includes a denial specificity requirement that changes how appeals work.

What Changed