From Mandate to Measurable Value
The Interoperability and Prior Authorization Final Rule CMS-0057 is reshaping how payers, providers, and patients exchange health data. It builds on CMS-9115 with expanded use cases, bi-directional APIs, and higher expectations across four tracks: Payer-to-Payer, Provider Access, Patient Access, and electronic Prior Authorization (ePA). Most provisions must be live by January 1, 2027, with key usage metrics due by March 2026.
When implemented well, CMS-0057 can unlock measurable business value — enabling faster, more informed clinical decisions, improving quality measures, and streamlining operations across the care continuum.
Onyx GA Products & Proven Playbooks
That’s exactly where Onyx comes in. Our solutions are already live with payers and recognized as Best in KLAS for CMS Payer Interoperability. We’ve led milestone firsts, from early CMS-0057 go-lives to the first combined claims + clinical data deployment in production.
Those real-world lessons form the backbone of our CMS-0057 Playbooks: detailed, practical guides to help you achieve compliance and capture the full opportunity CMS- 0057 offers. Each of our Playbooks include Compliance + Business Value – Designed to help organizations meet CMS-0057 requirements while improving health data exchange and care coordination.
- Step-by-Step Implementation – Detailed guidance on environment setup, testing, readiness, and integration, with visual diagrams and clear instructions
- Built-In Tools & Resources – Checklists, templates, and troubleshooting guides to reduce build-time and errors for a smooth go-live
- Beyond Baseline Compliance – Optional advanced features such as consent orchestration, analytics, and member-matching aids
- Clear Roles & Milestones – Defined responsibilities, success criteria, measurable outcomes, and a structured rollout plan to ensure progress
With this foundation, the Playbooks guide you from planning through go-live and optimization, backed by real-world lessons from live deployments of our products.
What’s Inside Our Playbooks
Start Here: Overview & Quick Start
Each Playbook opens with a plain-language summary of what the track is intended to achieve, who it impacts, and how it fits into both compliance and broader data-sharing goals. You’ll also find:
- Success criteria and measurable outcomes
- Prerequisites such as sandbox access, keys, and minimal configurations
- 30/60/90-day rollout snapshot to set expectations and keep momentum
- Ready-to-use checklists & quick-start templates to accelerate early progress
Who Does What: Roles, RACI & Responsibilities
Clarity of roles is essential. This section assigns responsibilities to Onyx, the client team, and any partners, with clear decision points and escalation paths.
We include role-specific tools and communication templates so every team member knows exactly what’s expected and when.
The Blueprint: Architecture, Data Flows & Core Capabilities
Visual diagrams show how the pieces fit together — from endpoints and identity management to logging and audit posture. Playbooks also detail what is included “out-of-the-box” for your track and cites relevant FHIR and regulatory references. Accompanied by configuration samples and message examples to simplify technical setup.
Tailored Enhancements: Advanced Options
For organizations aiming to extend beyond baseline compliance, we outline optional features such as consent orchestration, member matching aids, analytics, and integration adapters. Supporting templates make it easier to evaluate, scope, and integrate these enhancements.
Step-by-Step: Implementation & Integration
This section translates requirements into concrete actions, supplemented with troubleshooting guides and prebuilt workflow samples to keep projects moving:
- Environment setup (dev/test/prod)
- Mapping, IDs, network allowlists, and observability hooks
- Phased plans with deliverables and gating criteria
- Example sprint plans for planning purposes
Proving It Works: Testing, UAT & Readiness
Before launch, our Playbooks guide you through a comprehensive readiness process that ensures your solution is production-ready. This includes:
- Test data preparation
- Simulation scenarios
- Acceptance criteria and defect triage
- Track-specific UAT readiness checklists
You’ll also get reusable test scripts and defect triage templates to streamline validation, accelerate fixes, and maintain quality from first test through go-live.
Launch with Confidence: Go-Live & Hypercare
Outlines cutover steps, rollback plans, and stability objectives to maintain service quality during and after launch. Includes communication templates and checklists to ensure a smooth transition for both internal teams and external partners.
Measure & Optimize: Metrics & Monitoring
Includes guidance for collecting and reporting both regulatory usage metrics and operational KPIs, along with dashboard and alerting examples for ongoing oversight. Paired with ready-to-configure dashboards and reporting templates to track results in real time.
Get the Full Onyx Experience
Our Playbooks are practical, tested, and adaptable to your environment — built from live deployments and continually updated to reflect regulatory changes and real-world lessons. Paired with our Best in KLAS products and expert guidance from the Onyx team, they help simplify the complex, accelerate readiness, and minimize risk — ensuring a smoother go-live, sustained compliance, and a strong foundation for future growth and innovation.
Learn more about our GA CMS-0057 products, and how we’re helping payers meet the mandate while driving business value.