California Prior Authorization Requirements
A guide to prior authorization rules, turnaround times, and laws for medical practices operating in California (CA).
PA Turnaround Times
Standard Requests
5 business days
Urgent / Expedited
72 hours
PA Reform Legislation
AB 2024 and related legislation have strengthened PA turnaround requirements and added penalties for non-compliance. California has some of the strictest PA laws in the country.
Key Regulations
- Health plans must respond to standard PA requests within 5 business days
- Urgent PA requests must be processed within 72 hours
- Plans must have a process for expedited review when delay could jeopardize health
- DMHC oversees HMO compliance; CDI oversees PPO compliance
- Providers can file complaints with DMHC for PA delays or inappropriate denials
- Independent Medical Review (IMR) is available as an external appeal
California Medicaid PA
Medi-Cal (California Medicaid) is transitioning to managed care statewide. PA requirements vary by managed care plan. Medi-Cal requires PA for specialty medications, advanced imaging, and certain procedures.
Recent Changes (2025-2026)
- California continues to strengthen PA turnaround enforcement through DMHC
- Medi-Cal managed care expansion has changed PA workflows for Medicaid providers
- Increased penalties for plans that fail to meet turnaround deadlines
Top Payers in California
State Regulatory Body: California Department of Managed Health Care (DMHC) / Department of Insurance (CDI)
File PA complaints or appeals through your state insurance department.
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