CMS-0057-F Prior Authorization API compliance date
API obligations: Patient Access, Provider Access, Payer-to-Payer, Prior Authorization
Governance for utilization management and risk models
Rosetta semantic normalization beneath every API
Four API obligations, one deadline.
Impacted payers must have Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs operational by January 1, 2027. We scope against the rule text.
Prior Authorization API
Da Vinci ePA implementation with decision reasons and status returned in the format the rule requires.
Provider Access API
Claims, encounter, and clinical data exposure to contracted providers, with attribution and consent handled.
Payer-to-Payer
Member data portability at enrollment, including the five-year historical window.
Readiness, build, and governance.
Where we start.
Readiness assessment
Two weeks against the rule text: current API state, data gaps, vendor dependencies, and the work remaining before 2027.
Build and integrate
Standing up the APIs on normalized data, with the semantic layer that keeps ePA evidence computable.
Operate
Managed support for the interfaces and the reporting cadence once the APIs are live.
Map your API gap against the January 2027 deadline.
Thirty minutes with the interoperability practice.
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