What are the prior authorization turnaround requirements under CMS-0057-F?

Impacted payers must decide standard requests within 7 calendar days and urgent requests within 72 hours. These timeframes took effect January 1, 2026. QHP issuers on the Federally Facilitated Exchanges are excluded from the timeframe rule.

Do the turnaround rules apply to my practice?

No. The mandate falls on payers, not providers. Your practice has no 72-hour or 7-day deadline. The rule still affects you because payer decisions come faster and denials must state a specific reason.

When does the prior authorization decision clock start?

It starts when the payer receives a request with all required documentation. A coverage-requirements check by itself does not start the clock. Clean, complete submissions are what let the faster timeframe work in your favor.

What changed about denials?

Every impacted payer must now give a specific reason for each denial. Generic denial letters are out. That reason gives your billing team a concrete basis to correct, resubmit, or appeal.

What happens on January 1, 2027?

Impacted payers must run FHIR-based APIs, including a Prior Authorization API, Provider Access API, expanded Patient Access API, and Payer-to-Payer API. Providers will be able to check requirements and submit requests electronically instead of by fax or portal.

How should my practice prepare?

Submit complete requests, track payer decision times, log denial reasons, appeal with the stated reason, and get ready for electronic prior auth before 2027. Outsourcing prior authorization and denial management lets you adapt without adding staff.

CMS Interoperability Rule: New Prior Auth Deadlines 2026