Built by the people who help define the standards.
FHIR-native compliance for CMS-0057 and what comes next. We translate every new mandate into ready-to-execute architecture.
CMS-0057 is the current mandate — but the real value of getting compliance right goes beyond checking the regulatory box. The APIs you implement for compliance are the same data flows that feed risk adjustment, quality reporting, care gap closure, and population health. Build the foundation correctly and the data starts working for you across every program that depends on it. Build it poorly — or piecemeal across fragmented vendors — and you carry that technical debt into every clinical and operational initiative that follows.
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. For each one, Onyx provides a production-ready implementation, a demo preview, and a step-by-step implementation playbook — a preview of the operational guidance we provide to every Onyx customer.
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.
The Onyx CMS-0057 Final Rule guide covers the complete mandate scope, requirement by requirement — built for health plan teams who need to move from assessment to action.
FHIR, CMS mandates, and payer operations specialists — built these APIs in production across 50+ health plans
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Schedule a demo or take our complimentary CMS-0057 Readiness Check — a structured, expert-led review of your current API posture mapped against mandate requirements. Most health plans get their results within a week.
