Revised New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Comparison
Red denotes changes from previous chart.
| New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Chart | |
|---|---|
| SERVICE AUTHORIZATION REQUESTS | |
| Prior Authorization | Determination and Notice |
| Expedited | 72 hours from receipt* |
| Standard (Until 3/31/2026) |
3 business days after all info; no later than 14 days from receipt* |
| Standard (On or after 4/1/2026) |
3 business days after all info; no later than 7 days from receipt* |
| Certified Court MH or SUD Services | 72 hours from receipt |
| Inpatient Rehab Services After Inpatient Hospital Admission (Until 3/31/26) |
1 business day after all info; no later than 14 days from receipt* |
| Inpatient Rehab Services After Inpatient Hospital Admission (On or after 4/1/26) |
1 business day after all info; no later than 7 days from receipt* |
| Drugs the Health Plan is Responsible for Payment of | 24 hours from request |
| Concurrent Review | Determination and Notice |
| Expedited | 1 business day after all info; no later than 72 hours from receipt* |
| Standard (Until 3/31/2026) |
1 business day after all info; no later than 14 days from receipt* |
| Standard (On or after 4/1/2026) |
1 business day after all info; no later than 7 days from receipt* |
| Home Health Care After Inpatient Stay | 1 business day after all info; no later than 72 hours from receipt* |
| Home Health Care After Inpatient Stay if Next Day is Weekend/Holiday | 72 hours from receipt* |
| Inpatient SUD Requested 24 Hours Prior to Discharge from Inpatient Admission | 24 hours from receipt |
| Retrospective Review | Determination and Notice |
| 30 days after all info | |
| Reconsideration | 1 business day from receipt |
| OTHER ACTIONS | |
| Authorization Decisions Not Meeting Timeframe Requirements | Date of timeframe expiration |
| Reductions, Terminations, Suspensions | Notice at least 10 days in advance with exceptions (FH/aid continuing applies) |
| Payment Denials | Notice on date of Action |
| New York State Medicaid Managed Care Service Authorization and Appeals Timeframe Chart | |
| ACTION APPEALS | |
| Filing | 60 days from the date of Notice of Action |
| Acknowledgment | 15 days of filing |
| Determination | |
| Inpatient SUD Requested 24 Hours Prior to Discharge from Inpatient Admission | 24 hours from receipt |
| Expedited | 2 business days after all info; no later than 72 hours from receipt* |
| Standard (including Retrospective) | 30 days from receipt* |
| Notice | |
| Expedited (including Inpatient SUD Requested 24 Hours Prior to Discharge from Inpatient Admission) | Oral notice at resolution; written notice within 24 hours of determination but no later than 72 hours from receipt* |
| Standard | Written notice within 2 business days of determination; no later than 30 days from receipt* |
*Extension of up to 14 days permitted in certain circumstances.
Rev. 6/2026
