Starting January 1, 2026, the turnaround time for routine prior authorization requests for Medicare and Medicaid members will be seven (7) calendar days, down from fourteen (14) days. This change is part of the CMS Advantage Interoperability and Prior Authorization Final Rule and will impact Medicare and Medicaid members. Peer-to-peer discussions are allowed throughout the review process. Review the FAQ here for more information.
EviCore is continually working to enhance your prior authorization (PA) experience by streamlining and enhancing our overall PA process. You may notice incremental enhancements to our online interface and case-decision process. Should you have feedback regarding your experience, please provide it in the Web Feedback online form.