New Legislation in North Dakota and Nebraska on Prior Authorization Timelines

North Dakota and Nebraska have enacted new legislation, effective January 1, requiring insurers to expedite responses to prior authorization requests. In North Dakota, insurers must address nonurgent prior authorization within seven calendar days and urgent requests within 72 hours. If insurers fail to meet these deadlines, authorization is automatically granted. Governor Kelly Armstrong's approval of the bill signifies a strong commitment to streamlining insurance processes and enhancing regulatory compliance.

Similarly, Nebraska's regulations align closely, but with a future amendment: from 2028, urgent care response time will decrease to 48 hours. This change aims to boost prompt decision-making among insurers. On a parallel track, the Centers for Medicare & Medicaid Services (CMS) introduced rules in 2024 for Medicaid and Medicare Advantage plans, standardizing time frames of 72 hours for urgent cases and seven days for nonurgent ones. CMS Administrator Mehmet Oz, MD, highlighted these measures at an industry conference, stressing their role in alleviating patient frustration over authorization delays.

These regulatory updates echo a wider industry movement towards accelerating administrative procedures, compelling health insurance carriers to adjust operations for compliance. Streamlined AI-driven prior authorization processes not only align with new regulatory requirements but also enhance customer satisfaction by minimizing delays in medical service access. These advancements are crucial for insurers committed to effective risk management and underwriting practices, reinforcing their roles as efficient payers in the healthcare ecosystem.