CMS-0057, the Interoperability and Prior Authorization Final Rule, introduces four APIs that will shape how health data moves across the ecosystem:
- Payer-to-Payer Data Exchange – At the member’s request, securely transfer up to 5 years of their data when they switch plans.
- Provider Access – Give in-network providers access to a member’s data.
- Patient Access – Let members access and share their own claims, clinical, prior authorization and formulary data through apps.
- Electronic Prior Authorization (ePA) – Automate prior auth requests, documentation, and decisions with CRD, DTR, and PAS APIs.
These aren’t just regulatory checkboxes—they’re the rails for better continuity, transparency, and efficiency in everyday healthcare.
The Member’s Day: Data Ownership and Seamless Care
A member switches plans mid-year. Their new insurer instantly pulls claims and clinical history with Payer-to-Payer APIs, avoiding gaps in care. Through Patient Access APIs, they log into a mobile app to see their full health history, prescription coverage, and even the status of a prior authorization handled through ePA APIs.
Impact for members:
- No gaps in care.
- Existing Prior Authorizations are documented and shared with the new plan.
- Less paperwork and frustration.
- Empowerment through real ownership of their data.
The Provider’s Day: Accurate Attribution, Faster Decisions
A provider logs in to see their attributed member list — updated in real time thanks to Provider Access APIs. Later, when ordering a test, ePA APIs check requirements, pre-fill documentation, and deliver an approval decision in hours instead of weeks.
Impact for providers:
- Fewer disputes and phone calls.
- Greater trust in the data.
- Faster, smoother care for patients.
The Plan’s Day: Efficient Operations and Strategic Advantage
Behind the scenes, a plan’s operations team checks system dashboards. Payer-to-payer exchanges are running automatically, providers are retrieving accurate data, and prior auth requests are processed end-to-end without bottlenecks.
Impact for plans:
- Lower IT lift with no-code workflows.
- Faster cycle times and fewer provider complaints.
- A foundation for digital quality measures, risk adjustment, and value-based care.
Making CMS-0057 Real with Onyx
At Onyx, we’re helping payers move from mandates to production with solutions that are already live in market. Our focus is on making adoption achievable without heavy IT lift — and ensuring new APIs work within the realities of existing systems.
Here’s how we’re supporting customers:
- No-code workflows – Intuitive tools for attribution, member matching, and data transfers that business teams can manage directly.
- Developer enablement – OAuth flows, Postman collections, and portals that simplify integration and testing.
- Proven playbooks and FastTrack programs – Step-by-step guidance, timelines, and milestones that help teams go live faster and with confidence.
- Cloud flexibility – Deployments proven across Azure, AWS, and hybrid environments.
- Partner ecosystem – Collaborations with EHR vendors, UM partners, and data exchange networks to ensure interoperability across the care continuum.
- Built for integration – Designed to plug into existing payer infrastructure rather than replace it, reducing disruption while modernizing workflows.
- Industry leadership – Shaped by experts who contributed to the CMS-0057 implementation guides and are now guiding real-world adoption.
Together, these elements reduce risk, shorten timelines, and make CMS-0057 not just a mandate to meet, but an opportunity to build lasting digital infrastructure.
At Onyx, we’re helping payers put these capabilities into production — not in isolation, but as part of an ecosystem that integrates with existing infrastructure and partner systems. This practical support is what makes the mandate achievable. But the opportunity goes further.
APIs as Everyday Infrastructure
The real power of CMS-0057 is not just in meeting a mandate — it’s in creating infrastructure that supports the entire healthcare ecosystem. These APIs become the rails for continuity for members, trust for providers, and efficiency for health plans. Once in place, they open the door to broader initiatives like digital quality measures, risk adjustment, and value-based care.
APIs aren’t just a compliance requirement. They’re becoming everyday infrastructure — and the health plans that recognize that will be the ones positioned to lead.
For payers, the real challenge is less about what CMS-0057 requires and more about how to get there with speed, confidence, and minimal disruption. With the right approach — assessing readiness, identifying risks early, testing what works, and following a clear path to implementation — payers can move faster, reduce uncertainty, and go live with confidence.
Ready to take the next step?
Learn how we help payers prepare for CMS-0057 with our complimentary readiness check.