How ready is your health plan for CMS-0057-F?
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F, 89 FR 8758) is your organization's obligation. Operational timeframes were in force January 1, 2026. The four FHIR APIs come due January 1, 2027. The first public PA metrics were due March 31, 2026.
This assessment scores your readiness across five dimensions and identifies your top gaps. It takes about five minutes. No login required.
API Readiness
Patient Access · Provider Access · Payer-to-Payer · Prior Authorization API
PA Process Maturity
Decision timeframes, denial reasons, human-in-the-loop workflow
Public Reporting
Annual metrics, audit trail, machine-readable denial reasons
Integration
EHR · UM platforms · Provider and member portals
Operational Governance
Coverage policy, reviewer workflow, change management
Tell us about your health plan.
A few quick questions so we can tailor the recommendations. Not scored.
The four CMS-0057-F APIs.
Each must be in production by January 1, 2027 for Medicare Advantage, Medicaid FFS, and CHIP FFS. Managed care entities and QHP FFEs align on rating-period boundaries. Score each one by current maturity.
How prior auth runs today.
The operational requirements are in force as of January 1, 2026: 72 hours expedited, 7 calendar days standard. Specific clinical denial reasons are mandatory (no generic form language).
Reporting and audit trail.
The first annual non-drug PA metrics were due March 31, 2026 for CY 2025 data. Subsequent annual reports must be published every March 31. CMS-0062-P will add numeric counts (not just percentages) and new API-usage metrics for CY 2027 reporting.
The integration surface.
CMS-0057-F APIs do not run in isolation — they depend on healthy upstream EHR, UM, and portal integration. Integration debt is the most common cause of compliance slippage at this stage of the program.
Coverage policy, workflow, change management.
CMS-0057-F's effect on coverage policy operations is often underestimated. The DTR (Documentation Templates and Rules) workflow assumes coverage policy is structured and machine-readable. The denial-reason requirement assumes reviewer workflow is instrumented enough to attribute the reason to a specific criterion.
Your CMS-0057-F readiness report.
Per-dimension breakdown
Top gaps — and how to close them
The five lowest-scoring questions, ranked. Each lists the specific CMS-0057-F (or CMS-0062-P) implication, what to build to close it, and which HIP One capability addresses it.
Get the full report and a 30-minute call with our team.
We'll walk through your gaps in detail and show production-tested HIP One capabilities that map to each. No sales pitch — a working session.