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The 2027 API requirements of the CMS-0057-F will change how health plans exchange data and manage prior authorization. Complying with the new mandates will necessitate the adoption of connected systems, ensure the accuracy of information, and build efficient workflows. HealthAxis brings these capabilities together through its Enterprise Healthcare Operating System™ (EHOS), while its embedded Aipass™ intelligence helps process documentation, extract clinical information, and route prior authorization requests to support compliance readiness.
Download the infographic for a clear breakdown of the four CMS-0057-F APIs, the health plans affected, key 2027 requirements, and the operational changes needed to prepare for this rule. ↓
Frequently Asked Questions
What is CMS-0057-F?
CMS-0057-F is the CMS Interoperability and Prior Authorization Final Rule. It requires impacted payers to share data through FHIR APIs and meet prior authorization timeframes.
When do the CMS-0057-F API requirements start?
The API requirements generally begin January 1, 2027. Prior authorization decision timeframes began January 1, 2026.
Which APIs does CMS-0057-F require?
The Patient Access API (expanded), Provider Access API, Payer-to-Payer API and Prior Authorization API.
Who must comply with CMS-0057-F?
MA organizations, Medicaid and CHIP fee-for-service programs, Medicaid and CHIP managed care, and QHP issuers on the FFEs.
What are the prior authorization decision timeframes?
72 hours for expedited requests and seven calendar days for standard requests. QHP issuers on the FFEs are excluded from these timeframes.
