Medicare's 72-hour prior authorization decision rule for Advantage plans takes effect

Medicare's new rule requiring Medicare Advantage plans to issue prior authorization decisions within 72 hours is now in effect. This applies to both approvals and denials. The mandate aims to reduce delays in care for seniors. For billing teams, this means tracking turnaround times for Medicare Advantage PA requests. Document any delays that exceed 72 hours. This rule, part of the 2025 Medicare Advantage and Part D final rule, includes a 24-hour clock for expedited requests. Monitor payer portals and communications for updates on this policy. If a plan fails to meet the deadline, escalate internally and with the plan's provider relations department. This change directly impacts workflow for scheduling and patient access.