Minnesota Prior Authorization Law

What is prior authorization?

Prior authorization (PA)—also called utilization review—means the health plan must approve certain care before it will cover it. Doctors or hospitals often submit PA for you, but you still have rights if PA is denied.

A PA denial is different from a bill denial after care already happened. With PA, the fight is usually about whether the plan will allow the treatment at all.

Overview for any state: Prior authorizations. This page is Minnesota-only.

Confirm plan type: Minnesota: Start Here.

Minnesota PA rules

Minnesota's utilization review and PA standards are in Minn. Stat. ch. 62M, especially § 62M.05, § 62M.06, and § 62M.07. These rules apply to many fully insured Minnesota plans; traditional fee-for-service Medical Assistance has separate rules.

Standard (non-urgent) prior authorization

• Decision within 5 business days after the plan has information reasonably needed to decide (§ 62M.05, subd. 3a)
• Denial must include reasons, criteria on request, and how to appeal (§ 62M.05, subd. 3a(c)–(d))
• Plans must allow PA submission by phone, fax, voicemail, or electronic mechanism 24/7 (§ 62M.07, subd. 4)
• Approved PA generally cannot be retroactively revoked except for fraud, misinformation, or legal conflict (§ 62M.07, subd. 3)

Urgent / expedited prior authorization

• When the treating clinician says expedited review is warranted: decision as soon as the condition requires, but no later than 48 hours, including at least one business day after the request (§ 62M.05, subd. 3b)
• Expedited denial must also explain expedited internal appeal rights (§ 62M.05, subd. 3b(b))

2026 reforms (plans issued/renewed on or after Jan. 1, 2026)

• No PA for many outpatient mental health and substance use services (non-medication), NCCN-aligned non-medication cancer care, USPSTF A/B preventive services, pediatric hospice, and neonatal abstinence programs (§ 62M.07, subd. 2)
• Medications for mental health, SUD, and cancer still use the 48-hour expedited PA track (§ 62M.07, subd. 2(2)–(3))
• PA for chronic conditions does not expire unless the standard of treatment changes (§ 62M.07, subd. 5)

PA appeals

• Standard PA appeal decision within 15 days(up to 4 extra days if circumstances outside the plan's control) (§ 62M.06, subd. 3)
• Expedited PA appeal by phone; decision within 72 hours (§ 62M.06, subd. 2)
• Clinical denials reviewed by a physician who did not make the original adverse determination, in a matching specialty when possible (§ 62M.06, subd. 3(d), (g))

Federal CMS prior-authorization rules (7 calendar days standard / 72 hours urgent) also apply to many Marketplace, Medicare Advantage, and Medicaid managed care plans.

Where to look up PA rules

Each carrier publishes provider portals and member materials. Use your denial letter first—it should list how to appeal.

Carrier links: Minnesota prior auth & internal appeals links.

Shop or compare MNsure plans: MNsure plan comparison.

Medical Assistance

Minnesota Health Care Programs (Medical Assistance, MinnesotaCare managed care) use MCO prior authorization and appeal rules under federal Medicaid law and state manuals—not the same as ch. 62M for commercial insurance. MCO appeal often within 90 days of the action; state fair hearing under Minn. Stat. § 256.045 is a separate path after MCO exhaustion.

See Minnesota internal appeals for Medicaid steps.

If PA is denied

1. Read the denial for the appeal deadline and format.
2. Ask the treating clinician to submit a letter of medical necessity and records.
3. File an internal appeal with the plan (or complaint, depending on plan type).
4. If internal appeal fails, consider external review—see the external review guide.

Next: Minnesota internal appeals.

Urgent care

If delay could seriously harm the patient, ask the provider to request expedited PA and, if denied, an expedited internal appeal (48-hour PA decision track; 72-hour expedited appeal under § 62M.06, subd. 2). You may also qualify for expedited external review under § 62Q.73 after internal steps.

Emergency services cannot require prior authorization under § 62M.07, subd. 2(1)—notify the plan as soon as reasonably possible after emergency care.