NYS Medicaid Prior authorization timeframe update- 1/1/27

CMS released the new prior authorization timeline and NYS Medicaid was granted an extention on implementing the changes until 1/1/27.

What will change?

  • Timelines which are used to process standard prior authorization requests and expedited priorauthorization requests

New timeframe:

  • Standard prior authorization requests (under medical benefit) – new time is 7 days from the time that was received (considering that all of the required documentation is included).
  • However if not all required documents are included: NYS Medicaid may extend the request and by up to 14 calendar days
  • Failure to submit any requested documents will result in PA denial.

Expedited Prior Auth new timeframe:

  • The decision will be provided no later than 72 hours after the receiving the request. However,

For electronic requests – providers are encouraged to enroll to ePACES and eMedNY eXchange.

NYS DOH will amend the current 21 day prior auth timeframe- here.

For more info: CMS 2024 release here.

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