Issued: December 31, 2025
Partners Health Management is postponing changes related to the Interoperability and Prior Authorization Final Rule (CMS-0057-F) from Jan. 1, 2026, to July 1, 2026.
Partners previously issued a Provider Alert on September 5, 2025 outlining the upcoming changes from the Centers for Medicare & Medicaid Services (CMS) related to the Interoperability and Prior Authorization Final Rule. As a reminder, the federal establishes new timeframes for prior authorization decisions in state Medicaid and Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs:
- Expedited (urgent) requests must receive a decision within 72 hours
- Standard (non-urgent) requests must receive a decision within seven calendar days
What is happening?
- Partners will implement CMS-required changes effective July 1, 2026, as outlined in the previous provider alert: UM Update: Partners to Implement SAR Changes to Better Align with CMS published on Sept. 5, 2025.
- No changes will occur on Jan. 1, 2026.
What is changing?
- At this time, there is no change to the authorization review process. Changes will take effect July 1, 2026.
- Current UM prior authorization review processes and timeframes (14 days for standard requests, 72 hours for expedited) will remain in effect.
What do providers need to do?
- Providers do not need to take any action at this time.
- Providers should continue to follow current UM prior authorization processes and timeframes.
Who can providers contact if they have questions?
If providers have questions, they can contact:
- Tailored Care Management: TailoredCareManagement@PartnersBHM.org
- Utilization Management: UMQuestions@PartnersBHM.org
- Provider Network: PAS@PartnersBHM.org