Texas Prior Authorization Requirements
A guide to prior authorization rules, turnaround times, and laws for medical practices operating in Texas (TX).
PA Turnaround Times
Standard Requests
3 business days (HMOs), 15 business days (other)
Urgent / Expedited
24 hours (life-threatening)
Gold Card Law
Texas enacted one of the first gold card laws in the nation (HB 3459, 2021), exempting physicians with a 90% or higher PA approval rate from PA requirements. The law applies to commercial HMO and PPO plans regulated by TDI.
PA Reform Legislation
Texas is a national leader in PA reform with the gold card law, strict turnaround requirements for HMOs, and transparency mandates.
Key Regulations
- Gold card exemption for providers with 90%+ approval rate (HB 3459)
- HMOs must respond within 3 business days for standard requests
- Life-threatening conditions require 24-hour turnaround
- PA criteria must be publicly available
- Denial letters must include specific clinical reasons
- Providers can request peer-to-peer review
Texas Medicaid PA
Texas Medicaid (STAR, STAR+PLUS, STAR Kids) uses managed care. PA requirements vary by MCO. Texas Medicaid has its own turnaround requirements.
Recent Changes (2025-2026)
- Gold card law fully implemented with thousands of providers enrolled
- Legislature considering expansion of gold card to additional plan types
- TDI enforcement of turnaround time compliance
Top Payers in Texas
State Regulatory Body: Texas Department of Insurance (TDI)
File PA complaints or appeals through your state insurance department.
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