Built by the people who help define the standards.
FHIR-native compliance infrastructure for CMS-0057, CMS-0053, CMS-0062-P, CMS-4208-F2 Plan Finder provider directory modernization, and the mandates still ahead.
CMS-0057 is the immediate mandate — but it is no longer the only compliance signal payers need to plan for. CMS-0053, CMS-0062-P, CMS-4208-F2 Provider Directory / Plan Finder modernization, and future interoperability requirements are raising the bar for how health plans exchange, monitor, and use data. Getting compliance right builds a foundation that supports not only regulatory readiness, but also risk adjustment, quality reporting, care gap closure, and population health.
CMS-0057 introduces more than 50 new requirements for health plans across four APIs — most net new for payers, with interdependencies that make a piecemeal approach expensive and risky. Onyx provides production-ready implementation, demo previews, and step-by-step playbooks for each API, while helping plans build a foundation that can extend as CMS requirements continue to evolve.
It's all spelled out, step-by-step, and man — they are clear as day.
ePA is one of the most complex and operationally demanding workflows for health plans — touching clinical systems, UM vendors, and internal platforms. When it isn't well integrated it creates friction, rework, and delays across the ecosystem. When it runs reliably it delivers real operational value: reducing manual review and reprocessing, integrating authorization into existing provider workflows, and improving turnaround times and consistency.
Payer-to-Payer reduces friction and improves continuity when members move between plans. When it runs reliably it delivers immediate value — making onboarding smoother during plan transitions, supporting better care continuity with access to prior clinical history, and reducing delays that affect quality performance and the member experience. When clinical history moves with the member, workflows run more smoothly and downstream programs can begin sooner.
Provider Access enables payers to support provider access to patient data with clear visibility and control. As Balaji Narayanan, Chief Product Officer, puts it: Provider Access breaks down when access and control are in conflict. Getting this right removes that trade-off. When implemented correctly it delivers immediate operational value — with clarity before access, intentional requests, and controlled access throughout.
Patient Access gives members direct access to their claims, clinical, and coverage data through the apps they choose. Under CMS-0057 the upgrades are significant — expanded clinical data, Explanation of Benefits including vision and dental, and active prior authorization status. When implemented correctly it delivers immediate operational value — reducing member call volume, surfacing authorization status in real time, and establishing the data pipeline that Provider Access and Payer-to-Payer depend on.
Start with the CMS-0057 Final Rule guide to understand the immediate mandate scope, requirement by requirement — then use that foundation to prepare for the broader CMS compliance roadmap.
FHIR, CMS mandates, and payer operations specialists — built these APIs in production across 50+ health plans
View ServicesONYX COMPLIANCE
Schedule a demo or start with our complimentary CMS-0057 Readiness Check — a one-week, expert-led assessment that helps health plans understand current API posture, implementation gaps, and readiness for the broader CMS compliance roadmap.
