What Changes for Prior Authorization on January 1, 2027?
On January 1, 2027, Medicare Advantage, Medicaid and marketplace plans must run electronic prior authorization APIs. See what changes for small practices
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White paper
The Prior Authorization Rulebook 2026 to 2027
The federal deadlines now in force, the state gold card laws that let you skip authorization, which rule applies to which patient, and the front desk routine that prevents authorization denials.
10 pagesPlain language, no jargon
15 primary sourcesEvery figure dated and linked
2026 editionUpdated when the rules change
What is inside
- CMS 0057 F: the 72 hour and 7 day deadlines, denial reasons and the 2027 APIs
- WISeR: authorization in traditional Medicare in six states
- The 2025 insurer pledge and the 90 day continuity rule
- Gold card laws in six states, with thresholds and statutes
- Which rule applies to which patient, the front desk routine and the gold card tracker
Every paper in the WeBill Health library is written the same way: primary sources only for rules and numbers, every figure dated, a table wherever the rule varies by state or payer, and a worksheet or checklist at the end you can run on your own claims the same day.
Third party figures are quoted as published and are never mixed with WeBill Health's own metrics. Nothing in a paper is legal or payer specific advice. Confirm every deadline against your own contracts.
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