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72 hours to approve or deny. CMS just rewrote the rules.
Starting this year, health plans must respond to prior authorization requests within 3 days for urgent cases. Seven days for standard requests.
No more black holes. No more endless waiting.
The numbers are staggering:
📊 This affects 50% of all Medicare beneficiaries through Medicare Advantage
💰 Impacts 30% to 60% of revenue for Medicare and Medicaid heavy providers
⚡ Requires FHIR based APIs for electronic prior authorization across MA, Medicaid, CHIP, and ACA plans
But here’s what really matters:
Public metric reporting. Every plan must now publish their approval rates, denial reasons, and turnaround times.
Transparency as a forcing function.
Think about what this means for cancer patients waiting for treatment approval. For chronic disease management where delays compound suffering. For FQHCs trying to serve vulnerable populations efficiently.
The technology mandate is equally transformative. FHIR APIs aren’t just technical requirements, they’re infrastructure for a new healthcare operating system. One where data flows seamlessly between providers, payers, and patients.
Some health systems will struggle with implementation. The smart ones started preparing months ago.
The real winners? Patients who won’t die waiting for insurance approvals. Providers who can focus on medicine instead of paperwork. And tech companies building the rails for this new ecosystem.
This isn’t just regulatory compliance. It’s the beginning of healthcare’s digital transformation finally reaching the most broken part of the system: administrative burden.
The question isn’t whether this will work. It’s whether healthcare organizations are ready to operate at the speed their patients deserve.
♻️ Repost if prior authorization delays have hurt patient care in your practice
👉 Follow me, Jonathan Govette, for daily, real-time updates on healthcare technology and business news. LinkedIn Profile: https://www.linkedin.com/in/jonathangovette/
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Author:
Jonathan Govette is a seasoned healthcare and technology executive with more than two decades of experience building, scaling, and advising digital health companies. He is the Co-Founder and CEO of Oatmeal Health, an AI-driven Lung Cancer Screening and Diagnostics company focused on expanding access to early detection for underrepresented populations, particularly patients served by Federally Qualified Health Centers and value-based health plans.
With a background in engineering, product development, and strategic partnerships, Jonathan has founded and led multiple health technology ventures across clinical care delivery, regulated medical software, and AI-enabled diagnostics. His work sits at the intersection of medicine, technology, and health equity, with a consistent focus on translating complex clinical problems into scalable, real-world solutions.
Jonathan has spent much of his professional life dedicated to improving outcomes for marginalized and underserved communities. He has designed and implemented frameworks that align clinical quality, reimbursement, and technology to sustainably advance health equity at scale. This mission is deeply personal and informs his leadership philosophy and long-term vision for healthcare transformation.
In addition to his operating experience, Jonathan is an author and long-time writer in the healthcare domain, with over 20 years of published work covering digital health, medical innovation, and healthcare systems. He is a frequent mentor to early-stage founders and regularly advises startups on product strategy, partnerships, and go-to-market execution in regulated healthcare environments.
Before entering industry full-time, Jonathan nearly pursued a career in medicine with an early path toward cardiothoracic surgery, an experience that continues to shape his clinical perspective and respect for frontline care delivery.
CEO | Oatmeal Health | AI Lung Cancer Startup | Engineer | Writer | Almost Became a Doctor (Cardiac Thoracic Surgeon) | 3x Health Tech Founder | Startup Mentor | Follow to share what I’ve learned along the way.
