Medicaid Formulary Updates Effective 1.1.2026
Date: 11/17/25
Update: Standard Prior Authorization Turn Around Time
Effective January 1, 2026 & October 1, 2026
In September we communicated that beginning January 1, 2026, our review time for Medicaid and Medicare standard prior authorization requests will align with the new Centers for Medicare & Medicaid Services (CMS) requirement. AHCCCS has since confirmed Managed Care rules require the Medicaid prior authorization review time change to align with the AHCCCS contract year, making the official effective date October 1, 2026.
- Medicare: Must comply with the new CMS requirement starting January 1, 2026
- Medicaid: We will strive to comply beginning January 1, 2026, but official compliance is required by October 1, 2026
New Requirement:
- ·Standard prior authorization requests must be processed within 7 calendar days
- Under certain conditions, this may be extended up to 14 calendar days
Important Reminders:
- Submitting all required information upfront can speed up review time.
- Incomplete clinical information may result in delays, extensions or denial due to insufficient clinical support. To avoid delays, please submit complete clinical documentation with your initial request. This includes:
- Diagnosis
- Patient history and current condition
- Treatment plan and Interventions
- Relevant diagnostic tests
- Submit requests electronically using our secure provider portal or the Availity portal for faster processing.
- You can find all *Centene clinical policies and criteria on the Availity portal and specific clinical and payment policies in effect for Arizona are located on our website > For Providers > Provider Resources > Clinical & Payment Policies.
Questions?
Please contact your Provider Engagement Account Manager.
If you need their contact information, email us at: 📧 AzCHProviderEngagement@azcompletehealth.com
*Centene is the parent company of Arizona Complete Health-Complete Care and Wellcare by Allwell, Wellcare, and Ambetter from Arizona Complete Health.