Important Prior Authorization Updates (Effective July 1, 2026)

Date: 04/21/26

As part of our ongoing work to improve the prior authorization (PA) process for providers and members, Ambetter Health wants to share some important updates to our PA requirements. Our goal is to reduce administrative burden, simplify submission and approval processes, and facilitate timely access to appropriate, high-quality care.

Code change details are noted in the table below. The changes may include:

• Removing PA requirements based on criticality of review and clinical need
• Creating a more uniform set of PA requirements across our markets and lines of businesses, including adding and changing some PA requirements, to simplify processes, reduce confusion for providers, and support future efforts to expand real-time responses to requests.

For questions about specific prior authorization codes or how these changes may affect your practice, please reach out to your Provider Engagement Account Manager (PEAM).

Questions?

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

• Provider Support: Finding the Right Contact
• Provider Services: Call 1-877-687-1169
• Secure Provider Portal: Visit the Secure Provider Portal to check member eligibility, submit claims and more.
• Provider Engagement: Use the Find Your Account Manager tool to find the Provider Engagement Account Manager (PEAM) supporting your specialty and region.
• Provider News: Bookmark Ambetter Health Provider News and Sunshine Health Provider News to keep up with the latest updates.
• Provider Newsflash: Subscribe to our e-newsletter to get regular updates.
• Provider Resources: Visit Ambetter Health Provider Resources to find provider manuals, important forms, scheduling standards, and other provider resources.