CMS-0057-F
The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) establishes payer interoperability and prior authorization requirements. Impacted payers include Medicare Advantage organizations, Medicaid and CHIP programs and managed care plans, and Qualified Health Plan issuers on the Federally Facilitated Exchanges.
HTI-4 separately addresses ONC health IT certification.
Requirements and Timeline
| Timing | Requirements |
|---|---|
| Generally beginning January 1, 2026 | Operational requirements, including denial reasons, decision timeframes, and metrics reporting. Applicability varies by payer type. |
| Generally beginning January 1, 2027 | Patient Access API enhancements and new Provider Access, Payer-to-Payer, and Prior Authorization APIs. Exact compliance dates vary by payer type. |
| Calendar year 2027 | Electronic prior authorization reporting begins for applicable MIPS clinicians and Medicare Promoting Interoperability hospitals and critical access hospitals. |
The prior authorization provisions exclude drugs. CMS recommends the Da Vinci CRD, DTR, and PAS implementation guides; these recommendations are distinct from the rule's required API standards. Consult the CMS fact sheet for requirements and exceptions applicable to your organization.
Medplum Support
Medplum provides FHIR APIs, terminology services, FHIR profiles, and authentication infrastructure for organizations implementing payer interoperability workflows. Our electronic prior authorization guide describes connectivity and CRD testing with Medplum.
Drummond FHIRplace Validation
On October 1, 2026, Medplum v5 achieved Drummond Validated™ – FHIRplace Silver (CRD) status for the Q3 2026 testing cycle in two distinct roles:
| Role | Validation ID |
|---|---|
| Provider | FP-2026-Q3-001 |
| Payer | FP-2026-Q3-002 |
This validation recognizes confirmed CRD interoperability with multiple testing partners in a structured, production-representative environment. It applies only to Medplum v5, the listed roles, CRD use case, Silver tier, and Q3 2026. It does not cover DTR, PAS, other versions, or later testing quarters, and does not establish compliance with every CMS-0057-F requirement.
See Drummond's validation listing and testing reports and our announcement. Medplum is also pursuing ONC ePA certification, with no announced timeline.
Contact hello@medplum.com to discuss your implementation.
The Drummond Validated™ seal is a trademark of Drummond Group, LLC. HL7® and FHIR® are registered trademarks of Health Level Seven International. This validation does not represent an endorsement by any governing body.