
CMS-0057-F for payers in 2026: what shipping the API actually takes
CMS-0057-F (17 January 2024) mandates four FHIR R4 endpoints for impacted payers: Patient Access API (existing, prior-auth scope added), Provider Access API (new), Payer-to-Payer API (new), and Prior Authorization API (new).
Prior-auth decision clocks (7-day standard, 72-hour expedited) take effect 1 January 2026. The four FHIR APIs and public reporting of prior-auth metrics take effect 1 January 2027. The Prior Auth API uses Da Vinci PAS, CRD, and DTR.
Patterns that ship: managed FHIR back-ends (MedPlum, Aidbox, Google Cloud Healthcare API, Azure Health Data Services, AWS HealthLake) over custom builds; Da Vinci IGs adopted as written; one SMART on FHIR member-app surface; member attribution agreed with the EHR side first.
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