Glossary · National systems
CMS-0057-F
CMS Interoperability and Prior Authorization final rule
CMS-0057-F is the US final rule of January 2024 that extends CMS-9115-F and requires impacted payers to add FHIR-based Provider Access, Payer-to-Payer and Prior Authorization APIs.
Some of its provisions apply from 1 January 2026 and most API requirements from 1 January 2027; under CMS enforcement discretion, payers may run FHIR prior authorization without the X12 278 transaction.
Official source
CMS: Interoperability and Prior Authorization final rule (CMS-0057-F)
See also
Definitions written by Anpheros from the official sources linked on each page. General information about standards and regulation, not legal or medical advice. All terms →