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 […]
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 […]
What WEDI’s Latest CMS-0057 Survey Really Tells Us About Industry Readiness
By Mark Scrimshire, Chief Interoperability Officer, Onyx WEDI’s newest CMS-0057 survey (Nov 2025) provides an important snapshot of where payers and providers stand as the industry prepares for the January 2026 and January 2027 milestones. The results show that progress is underway, but they also reveal places where uncertainty about scope and sequencing is slowing planning. Across the […]
Inside the Onyx CMS-0057 Playbooks
From Mandate to Measurable Value The Interoperability and Prior Authorization Final Rule CMS-0057 is reshaping how payers, providers, and patients exchange health data. It builds on CMS-9115 with expanded use cases, bi-directional APIs, and higher expectations across four tracks: Payer-to-Payer, Provider Access, Patient Access, and electronic Prior Authorization (ePA). Most provisions must be live by […]
Who is Impacted by the Prior Authorization Rule?
Learn who is impacted by the CMS Prior Authorization Rule (CMS-0057)
What is the CMS-0057 Rule?
CMS Recently released the Prior Authorization Rule (CMS-0057). What is it about?