Prior Authorization Changes
Effective January 1, 2026, Med-QUEST will adjudicate prior authorization requests under standard and expedited timeframes. Additionally, deferral timeframes will be revised to align with new federal requirements. As applicable, these updates apply to provider types subject to prior authorization requirements.
Standard Prior Authorization Requests
Med-QUEST will adjudicate standard prior authorization requests within seven calendar days from the date received, provided all necessary documentation is included. This includes all relevant information about the member, clinical attachments, and any additional notes required to demonstrate compliance with the prior authorization submission standards. For detailed submission requirements, please refer to the applicable provider manual.
Deferred Prior Authorization Requests
In instances when prior authorization requests are deferred (for example, due to incomplete or missing documentation), the timeframe for review may be extended by up to 14 days from the date of the deferral.
Expedited Prior Authorization Requests
Med-QUEST will review expedited prior authorization requests within 72 hours when the member’s clinical condition requires urgent attention and a delay in processing could negatively affect health outcomes. If the request does not meet the criteria for expedited review, it will be processed as a standard request and follow standard review processes, including the deferral process, as applicable. Please note that changes to the date of a scheduled procedure, or the sudden availability of clinical services, do not qualify as reasons for an expedited prior authorization. Expedited review is only for urgent cases where a delay could cause serious harm. It is not for convenience, preference, or routine care.
Metrics Reporting
Effective March 31, 2026, Med-QUEST will post prior authorization metrics to Medquest.hawaii.gov. The metrics will be updated on an annual basis. The following aggregated prior authorization metrics for all other items and services will be available.
