CMS-0057-F Fundamentals
Start here if you are new to the rule. These pages summarize the regulation, its deadlines, and what is already in force.
CMS-0057-F Fact Sheet
Requirements, the four APIs, FHIR standards, and implementation deadlines at a glance — the primary reference hub.
StatusWhat's in Effect in 2026
Which prior authorization process requirements are already live versus the January 2027 API deadlines.
TimelineCompliance Timeline
Phased deadlines, extension pathways, and enforcement across payer types.
Required APIs
Detailed references for each of the four FHIR APIs mandated by the rule.
Patient Access API
Consumer-facing FHIR access to claims, clinical data, and prior authorization information.
APIProvider Access API
Attributed-patient data access for in-network providers, including architecture and a payer checklist.
APIPayer-to-Payer API
Automated data exchange when members change plans — consent, provenance, reconciliation, and build-vs-buy.
APIPrior Authorization API
Electronic PA discovery, documentation, and submission via the Da Vinci CRD/DTR/PAS workflow.
FHIR and Da Vinci
Deeper technical guides for the standards and Da Vinci implementation guides that underpin the rule's APIs.
FHIR for CMS-0057-F
A practical FHIR guide for health plans: where FHIR fits across all four APIs, US Core, Da Vinci, SMART on FHIR, terminology, and mapping FHIR to existing payer data models.
GuideCRD, DTR & PAS Explained
How the three Da Vinci prior authorization implementation guides fit together, where the payer API boundary sits, and where X12 still appears.
Payer Architecture & Core Administration
How the CMS-0057-F interoperability layer fits with established core administration platforms.