Are you ready for CMS-0057-F?
The CMS Interoperability and Prior Authorization Final Rule is two different problems depending on which side of the wire you sit on. Pick the assessment that matches your organization — each is calibrated to the dimensions that actually move the needle for that side.
You are an impacted entity. The four FHIR APIs, the 7-day / 72-hour timeframes, the annual public metrics — they all apply directly to your organization. This assessment scores compliance posture.
- API Readiness — the four mandated FHIR APIs
- PA Process Maturity — timeframes, denial reasons, reviewer workflow
- Public Reporting — March 31 metrics, audit trail
- Integration Maturity — EHR, UM, portal
- Operational Governance — coverage policy, change management
The rule doesn't regulate you directly — but its operational consequences land on the provider side. EHR readiness, submission workflow, denial intake, payer visibility, patient experience. This assessment scores opportunity capture.
- EHR & Workflow Integration — FHIR R4, CRD hooks, DTR templates
- PA Submission & Workflow — channel mix, gap analysis, appeals
- Revenue Cycle & Denials — structured denial intake, first-pass rate
- Payer Visibility & Network Intel — TAT tracking, gold-carding
- Patient Experience — PA status visibility, education, coordination
The short version of the rule.
CMS-0057-F (89 FR 8758, published January 17, 2024) is the CMS Interoperability and Prior Authorization Final Rule. It applies directly to Medicare Advantage organizations, state Medicaid FFS programs, Medicaid managed care plans, CHIP FFS, CHIP managed care entities, and Qualified Health Plan issuers on Federally-Facilitated Exchanges. It does not regulate provider organizations directly — but providers depend on the APIs and workflows the rule mandates, and the operational changes it forces on payers reshape the prior-auth experience for everyone downstream.
Major effective dates: operational PA timeframes (7 calendar days standard, 72 hours expedited) came into force January 1, 2026. The first public PA metrics were due March 31, 2026 for CY 2025 data. The four FHIR APIs — Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization — come due January 1, 2027 for MA, Medicaid FFS, and CHIP FFS, with rating-period alignment for managed care entities and QHP FFEs. CMS-0062-P (the follow-on proposed rule, March 2026) extends the framework to drug PA with an October 2027 compliance horizon.