Earlier this week, the Centers for Medicare & Medicaid Services (CMS) hosted its sixth Interoperability and Prior Authorization Connectathon, a three-day virtual event attended by more than 1,500 healthcare and health IT professionals. Onyx Health was proud to take an active role in this industry milestone, showcasing how our platform, OnyxOS, is already delivering the capabilities payers and providers need to comply with the CMS-0057-F Final Rule.
From prior authorization automation to payer-to-payer data exchange, our demonstrations spanned multiple tracks and validated end-to-end workflows in collaboration with our partners and peers. Here’s a quick recap of what we showed, and why it matters.
1. End-to-End Electronic Prior Authorization with Itiliti Health
In the Burden Reduction Track, Onyx teamed up with utilization management partner Itiliti Health to successfully execute a full Electronic Prior Authorization (ePA) process using all three required HL7 FHIR® Implementation Guides (IGs):
- CRD (Coverage Requirements Discovery)
- DTR (Document Templates and Rules)
- PAS (Prior Authorization Support)
Using a SMART-on-FHIR app, we pulled real-time clinical data from an EHR’s FHIR API, checked authorization requirements via CRD, and triggered downstream workflows—including auto-populated questionnaires driven by Clinical Quality Language (CQL). The completed bundle was submitted through OnyxOS for prior authorization processing, with status updates and claims responses exchanged seamlessly between payer and provider systems.
2. Translating Claims into Patient-Accessible Prior Auth Records
In the Payer Data Exchange (PDex) Track, Onyx extended the prior authorization workflow further by transforming claims responses into PDex-compatible records. This meant:
- Generating prior auth records in FHIR format
- Exposing them through the Patient Access API, alongside related clinical data
- Ensuring patients gain visibility into their prior authorization decisions as required by CMS-0057
While the Connectathon didn’t allow time to test the new Formulary IG structures, Onyx also showcased support for expanded Attribution Lists for Provider Access and bulk member matching capabilities for the Payer-to-Payer API.
3. Leading the Way on CMS-0057 Compliance
Among all Connectathon participants, Onyx was the only vendor to demonstrate full end-to-end support across the CMS-0057 regulation’s scope. From ePA to member attribution to patient and provider APIs, our team proved that the technology to meet—and exceed—these requirements is already here.
Our participation across multiple Connectathon tracks is more than a technical validation—it’s a reflection of our ongoing commitment to helping health plans reduce burden, improve transparency, and enable real-time, standards-based data exchange.
Are You Ready for CMS-0057? We Are. Let’s Talk.
The clock is ticking toward March 2026 and January 2027 CMS deadlines. Whether you’re just starting your compliance journey or seeking a modern, modular platform to scale your efforts, Onyx Health is here to help.
Schedule a strategy session with our team to learn how OnyxOS can accelerate your readiness and help turn regulatory burden into operational advantage.