What 2027 asks of health plans: four pressures, one data foundation
By Susheel Ladwa, Onyx CEO January 1, 2027 is a crowded date for health plans. The four FHIR APIs required under CMS-0057-F go live. Medicaid expansion adults move to six-month redeterminations and work requirements. A new Medicare Advantage payment year starts under revised risk adjustment rules. All of it lands during the steepest commercial cost […]
What Black Book’s Payer Interoperability KPIs Tell Health Plans About Reliability, Governance and Production Operations
Black Book’s 2026 payer interoperability research evaluates vendors across 18 key performance indicators. In this series, I’m looking at those KPIs in five practical areas through the lens of what it actually takes to build, operate and scale payer interoperability infrastructure. In Part 1, Building for Evolving Mandates, I looked at the regulatory, API and […]
What Black Book’s Payer Interoperability KPIs Tell Health Plans About Making Clinical Data Work in Production
Black Book’s 2026 payer interoperability research evaluates vendors across 18 key performance indicators. In this series, I’m looking at those KPIs in five practical areas through the lens of what it actually takes to build, operate, and scale payer interoperability infrastructure. Onyx ranked #1 overall in the research, leading 11 of the 18 KPIs. In Part 1, I looked at regulatory readiness, […]
What Black Book’s Payer Interoperability KPIs Tell Health Plans About Building for Evolving Mandates
Black Book’s 2026 payer interoperability research evaluated vendors across 18 key performance indicators, based on feedback from 764 qualified payer respondents. Onyx ranked #1 overall and earned the top score in 11 of the 18 KPIs. The 18 measures span much more than basic API functionality. They look at everything from regulatory readiness, standards conformance […]
The CMS-0057 API Health Plans Are Already Using for Value-Based Care
CMS-0057 requires health plans to make claims, encounter, clinical, and prior authorization information available to providers through standardized APIs. But Provider Access does not have to be built for compliance alone. Health plans are already implementing the API in production to support value-based care contracts—extending the same interoperability foundation to give at-risk providers the information […]
CMS-0057 and CRD: Giving Providers Answers Before the Patient Leaves
A prior authorization answer delivered while the patient is still in the office can create a very different care experience than one that arrives days later. Without real-time information, a provider may have to send the patient home, confirm requirements with the health plan, reconnect by phone, and schedule another appointment. That delay is not […]
CMS-0057: Bringing Claims and Clinical Data Together to See the Full Member Story
Health plans have never lacked data. They’ve lacked a complete picture. Member history is often spread across providers, health plans, and disconnected systems, making it difficult to understand the full care journey when important decisions need to be made. CMS-0057 begins to change that. Through Patient Access, Provider Access, and Payer-to-Payer APIs, the rule creates […]
The API Works. The Network Is What Makes CMS-0057 Matter.
For health plans preparing for CMS-0057, standing up secure APIs is only one part of the work. The larger challenge is making those APIs exchange data with organizations outside the plan’s own environment — securely, reliably, and at scale. “The network becomes really powerful. It allows you to really move beyond, ‘I can get connected,’ […]
The Fax Machine Is Still Winning. Here’s How CMS-0057 Changes That.
Same payer. Two patients. Two completely different experiences. The first is on a Medicare Advantage plan — prior auth answered in seconds at the point of care, provider moves on with treatment. The next patient walks in on an employer plan with the same payer. Same provider. Same office. Different answer: send a fax. “The […]
From the Frontlines: CMS-0057 Is a Data Maturity Test
By Dinesh Y V, Implementation Manager, Onyx Electronic prior authorization requires more than APIs. As CMS-0057 moves from planning to execution, implementation teams are seeing where the real friction lives: fragmented payer data, inconsistent rules, and governance gaps that become visible in real-time workflows. The healthcare industry has spent years discussing interoperability, automation, and digital transformation. CMS-0057 is […]