Pennsylvania prior authorization laws (2026)
General reference compiled from public statutes and the AMA state-law chart. This is not legal advice. Statutes change; confirm the current law before relying on it.
Patient-protection mandates
Retrospective Denial Prohibition
A PA determination is binding on the insurer; a plan cannot deny a closely related service for lack of PA if notified within 3 days before claim submission.
Pennsylvania Act 146 (2022) · sourceFrequently asked questions
What prior authorization patient protections does Pennsylvania have?
Pennsylvania law includes retrospective denial prohibition. Each is grounded in a specific statute (see above).
Other states
Track these rules automatically
Praxigen keeps payer requirements and the regulations around them current, so your submissions and appeals reflect the rules in force today.