CMS-0057 Was Just the Start: Building the Right Foundation for CMS-0053
Health plans have spent the last several years preparing for CMS-0057. That work has focused on APIs, FHIR implementation, prior authorization workflows, and the January 1, 2027 deadline. That progress matters. But as organizations move from planning to production, a broader reality is coming into view: interoperability is not just about whether data can move. It is […]
The Architecture Behind Intelligence: A Conversation with Dragon Bashyam
By Susheel Ladwa, CEO, Onyx Moving clinical data is no longer the hard part. Using it is. Payers today receive clinical information from dozens of sources — provider EHRs, public health systems, exchange partners — and most of it arrives fragmented, inconsistent, and hard to operationalize. Connectivity is solved. Intelligence isn’t. I wrote recently about […]
Prior Authorization: The View from Backstage
By Immanuel Anthony, Tech Contributor, Onyx Everyone in healthcare IT knows prior auth is broken. Fewer people have stood backstage and watched exactly how it breaks — and what it takes to fix it at the infrastructure level. That’s where this piece comes from What the messy reality looks like The premise of prior auth […]
CMS Is Modernizing Medicare Plan Finder. Here’s What MA Plans Need to Do Now.
The days of static provider directories are numbered. CMS is building a National Provider Directory powered by FHIR-based APIs, and starting October 1, 2026, the Medicare Plan Finder will begin ingesting provider and facility data directly from Medicare Advantage plans’ publicly accessible Plan-Net APIs. If your API isn’t ready, your plan data won’t show up […]
Completing the Chain of Trust for CMS-Aligned Networks
How HL7 Da Vinci and FAST Security work together to support scalable payer interoperability By Mark Scrimshire, Onyx Chief Interoperability Officer CMS-Aligned Networks Raise the Bar As CMS accelerates its Health Technology Ecosystem and the vision for CMS-Aligned Networks continues to take shape, the interoperability conversation is shifting. The question is no longer simply whether organizations can expose APIs. […]
Portable Trust Credentials: Why Now and How to Get Started
By Mark Scrimshire, Chief Interoperability Officer, Onyx In my previous article, I explained how verifiable connectedness works as a mechanism for portable trust in healthcare interoperability. Today I want to address the practical questions: Why is now the right time to act? What does adoption look like? And what’s the business case? Why Now: The Convergence of Three Forces Three forces are […]
Where Payer-to-Payer Succeeds or Fails in Production
What payer teams encounter once real data and scale are introduced By Balaji Narayanan, Chief Product Officer, Onyx Payer-to-Payer Data Exchange is a CMS-0057 workflow designed to transfer clinical history between payers when members change health plans. When executed reliably at scale, it establishes consistent data movement and enables downstream use across quality, utilization management, and risk programs. In […]
Spotlight on PTAC: Strengthening the Data Foundation Needed for True Patient Empowerment
A National Focus on Patient and Data Empowerment The Physician-Focused Payment Model Technical Advisory Committee (PTAC) centered the agenda of its recent public meeting on a unifying theme: how data and health IT can transparently empower consumers and better support providers. PTAC’s role as an advisory body to HHS positions it uniquely to surface the structural challenges preventing patients from fully benefiting from digital tools, coordinated […]
CMS Is Pushing the Interoperability Envelope
By Mark Scrimshire, Chief Interoperability Officer, Onyx CMS hosted a special Health Tech Ecosystem Connectathon last week in Washington, DC — a one-day event that brought together nearly 300 participants from across payers, providers, vendors, federal agencies, and standards groups. The size and composition of the crowd made one thing clear: CMS isn’t just regulating interoperability. They are accelerating the ecosystem needed to make it […]
CMS-0057 Readiness: Challenges We’re Seeing and How Health Plans Can Move Forward
By Mark Scrimshire, Chief Interoperability & Security Officer, Onyx Health; Co-Chair, HL7 Financial Management Work Group; active contributor to WEDI The reality today By January 1, 2027, health plans are expected to have APIs live across Patient Access, Provider Access, Payer-to-Payer, and electronic Prior Authorization (ePA). Earlier this year, WEDI’s baseline survey found that 43 […]