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 […]
A Day in the Life of CMS-0057: What It Means for Members, Providers, and Health Plans
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 […]
Practical Approaches to CMS-0057 Compliance: Starting Strong and Staying on Track
The January 2027 CMS-0057 deadline is fast approaching. Some health plans are deep into execution, others are running pilots, and many haven’t yet made key decisions. No matter where you are, one thing is certain: the runway is shrinking, and the stakes are high. At Onyx, we’ve already taken customers live on CMS-aligned APIs and […]
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 […]
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.
Not Happy with your CMS Interoperability Platform? There is a solution for that…
The implementation of the CMS Interoperability mandate has proven challenging for many Health Plans. The rule requires publishing a standards-based Patient Access and Provider Directory APIs, and initiating payer-to-payer data exchange. Are you facing issues maintaining your API platform? Is your vendor responsive? Is your current vendor sunsetting their support? You may be considering your […]
What’s the difference between “Patient Access API” and “Provider Access API”?
The latest Proposed rule from CMS addressing Prior Authorization (December 13, 2022) also expands the Patient Access API and adds a Provider API. Provider Access API and Patient Access API are two types of application programming interfaces (APIs) that allow different types of users to access member health information. Both are based on HL7 Fast […]