By Mark Scrimshire, Chief Interoperability & Security Officer, Onyx Health; Co-Chair, HL7 Financial Management Work Group; active contributor to WEDI
The reality today
By January 1, 2027, health plans are expected to have APIs live across Patient Access, Provider Access, Payer-to-Payer, and electronic Prior Authorization (ePA).
Earlier this year, WEDI’s baseline survey found that 43 percent of payers had not yet begun API work, and only about a third were partially underway. There’s no question now that progress is happening, but as 2025 ends, the pace varies widely from plan to plan.
Several health plans, including those we’ve worked with directly, are now live with CMS-0057 APIs. But for many others, the move from planning to implementation has surfaced new challenges in coordination, testing, and integration.
Across conversations with payers, the same message comes through clearly: the biggest risks aren’t technical. They’re about aligning expectations, defining ownership, and coordinating across vendors and internal teams — the factors that determine whether projects move smoothly from design to production.
The mandate is clear; what separates leaders now is their ability to turn plans into production.
What’s holding payers back
Across the market, and in our customer work, the same execution barriers continue to surface:
- Governance and decision rights. Unclear ownership slows decisions across compliance, IT, and operations.
- Vendor handoffs and sequencing. Gaps appear at the boundaries—who builds what, and in what order.
- Test environment parity and readiness. Non-production environments don’t mirror production, creating late-stage surprises.
- Resource strain. Teams are juggling 2026 metric reporting while building toward 2027.
- Data and architecture alignment. Identity, consent, and monitoring inconsistencies hinder real interoperability.
What’s helping across the industry
The payers making measurable progress share a common mindset: they’re thinking beyond compliance. Rather than viewing CMS-0057 as a box to check, they’re using it as a foundation for improving quality, risk adjustment, and member experience — and building long-term operational strength.
Across the market, a few patterns are emerging:
- Clear governance and accountability. Successful organizations are formalizing decision rights and ensuring cross-functional ownership from the start.
- Incremental delivery and validation. Instead of trying to solve every track at once, leading payers are running smaller, production-like pilots to build confidence and uncover issues early.
- Shared understanding across teams. IT, compliance, and business units are meeting more regularly to align timelines, dependencies, and test criteria before go-live.
- Vendor transparency and collaboration. The most effective partnerships are rooted in shared visibility into sequencing, environments, and readiness checkpoints.
These patterns reflect a shift from compliance as project management to compliance as operational discipline — a mindset that positions plans to move faster, reduce risk, and deliver sustainable value.
How Onyx is supporting payers
At Onyx, we’re working side-by-side with health plans at every stage of CMS-0057 implementation — helping them accelerate go-live, reduce risk, and capture more value from their interoperability investments. Here are some of the solutions and approaches that are helping payers simplify complexity and build confidence:
- Readiness Check — a rapid but thorough one week assessment that gives teams a clear view of where they stand today, where risks exist, and what steps will drive measurable progress.
- Proof Run (Provider Directory / Plan-Net) — a production-like pilot that validates core infrastructure (identity, hosting, monitoring, CI/CD) before scaling to other tracks.
- Playbooks — practical, step-by-step guides with defined roles, readiness checklists, and cutover/hypercare templates, continually updated from live payer deployments.
These tools reflect insights from our engagement in HL7 and WEDI and the real-world lessons we learn alongside payers every day. They’re designed to help organizations turn regulatory requirements into measurable value—efficiently and confidently.
Know where you stand — and what to do next
As 2026 usage metrics and the 2027 API deadline approach, health plans can’t afford to rely on assumptions. The Onyx Readiness Check delivers a clear, actionable assessment of your current state, gaps, and next steps — before deadlines or dependencies slow you down. No cost, no commitment.