Updates to prior authorization timeframes

Washington State Health Care Authority sent this bulletin at 01/14/2026 09:49 AM PST

January 14, 2026

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Updates to prior authorization timeframes

Beginning January 1, 2026, providers have a shortened response time to requests for additional information as per Code of Federal Regulations Title 42, §438.210 -- Coverage and authorization of services.

The Apple Health (Medicaid) contracted managed care organizations must make determinations on standard prior authorization requests no later than 7 calendar days after receiving the request. The new regulation shortens the timeframe for providers to respond to requests for additional information from 7 calendar days to 4 calendar days.

Expedited authorization requests must be determined no later than 72 hours after receiving the request. The provider must send any requested additional information within 24 hours of receiving the request for additional information from the managed care organization.

Contact

Email: HCA managed care programs

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.