CMS-0057 Readiness: Challenges We’re Seeing and How Health Plans Can Move Forward
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 […]
Inside the Onyx CMS-0057 Playbooks
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 […]
Better Data = Better Care
We’re All In. A CMS-Aligned Network Yesterday’s announcement from The White House, U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services is a clear call to action: build health tech that actually works for the people who use it. At Onyx, we’re all in, guided by our purpose of […]
Onyx Health at the CMS July 2025 Connectathon: Demonstrating Real-World Readiness for CMS-0057
This week CMS held its sixth Connectathon, a three-day virtual event with 1,500 registered attendees. The Onyx team was there demonstrating OnyxOS and the capabilities that enable payers and providers to support the requirements of the CMS Prior Authorization regulation (CMS-0057).
How OnyxOS and HL7 FHIR Standards Enable Payers and Providers to Meet Price Transparency Mandates
The healthcare industry is being pushed towards greater transparency, and a new driver of this change is the Presidential Executive Order Empowering Patients through Radical Price Transparency. Onyx can help.
Who is Impacted by the Prior Authorization Rule?
Learn who is impacted by the CMS Prior Authorization Rule (CMS-0057)
What is the CMS-0057 Rule?
CMS Recently released the Prior Authorization Rule (CMS-0057). What is it about?
HLTH is just around the corner
HLTH 2023 is upon us (October 8-11). Let’s meet! There is so much to talk about with the acceleration of the adoption of FHIR for Interoperability.
CMS Releases the rule many have been waiting for
CMS Advancing Interoperability and Improving Prior Authorization Processes proposed rule. 403 Pages of Transformative Regulation dropped yesterday, December 7, 2022. (https://public-inspection.federalregister.gov/2022-26479.pdf) The Proposed rule will be officially published on the Federal Register on 12/13/2022. it covers: A. Patient Access API B. Provider Access API (Bulk FHIR) C. Payer to Payer Data Exchange on FHIR D. […]
Prior Authorization: A Business Problem In Need Of Regulation
Prior Authorization: A Business Problem In Need Of Regulation. Regulations must address how providers can discover whether a prior authorization is required and, if required, what information needs to be sent with the request