Prior Authorization in California
California has some of the most comprehensive PA reform laws in the nation. AB 2850 and SB 250 require health plans to decide standard PA requests within 5 business days and urgent requests within 72 hours. California also enacted AB 2660 (2022) mandating electronic PA and gold-carding provisions for providers with high approval rates.
Key Facts About PA in California
- ✓ Standard PA decisions required within 5 business days; urgent within 72 hours
- ✓ Gold card provisions exempt high-performing providers from repeat PA for certain services
- ✓ The DMHC and CDI both oversee PA processes depending on plan type
- ✓ California Medicaid (Medi-Cal) has its own PA and step therapy rules
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in California
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these California carriers:
Kaiser PermanenteAnthem Blue CrossBlue Shield of CaliforniaUnitedHealthcare