Manage CMS-0057-F from one place
Host the Prior Authorization API, support Patient Access, Provider Access and Payer-to-Payer, and track readiness across the rule.
What the rule asks for, and where Prismaid fits
Jan 1, 2026
Decision timeframes and specific denial reasons
Mar 31, 2026
First annual public prior authorization metrics
Jan 1, 2027
Prior Authorization, Provider Access and Payer-to-Payer APIs, plus prior authorization data in Patient Access
| Requirement | CMS date | Prismaid's role |
|---|---|---|
| Prior Authorization API | Generally Jan 1, 2027 | Prismaid hostsHosted by Prismaid: PAS, CRD and DTR, with X12 278 translation and a sandbox. |
| Patient Access API | Prior authorization data generally Jan 1, 2027 | Prismaid supportsServed by your FHIR platform. Prismaid publishes prior authorization data to it and records annual usage counts. |
| Provider Access API | Generally Jan 1, 2027 | Prismaid supportsServed by your FHIR platform. Prismaid manages attribution rules, the opt-out registry and endpoint checks. |
| Payer-to-Payer API | Generally Jan 1, 2027 | Prismaid runs outboundPrismaid runs outbound exchange: opt-in cases, previous payer tracking, member match and retries. Your FHIR platform serves inbound requests. |
| Decision timeframes | Generally Jan 1, 2026 | Prismaid tracksTracks 72-hour and 7-day clocks, extensions and overdue cases. |
| Specific denial reasons | Generally Jan 1, 2026 | Prismaid tracksRequires a denial reason per line, with a denial code map for each plan. |
| Public prior authorization metrics | Annually from Mar 31, 2026 | Prismaid publishesCalculates metrics, routes them for approval, and publishes HTML, JSON and CSV pages. |
Exact dates vary by payer type. The rule covers Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and QHP issuers on the Federally Facilitated Exchanges. Decision timeframes don't apply to QHP issuers on the FFEs, and the rule's prior authorization policies exclude drugs. See the CMS fact sheet for details.
Follow one prior authorization request through your stack
- 1Is prior authorization needed?CRD answers CDS Hooks calls from the provider system.
- 2Here is what to documentDTR serves questionnaires, including adaptive questions, from content you host locally or remotely.
- 3Submit the requestPAS accepts submissions and inquiries.
- 4Pass it to your UM systemThrough a built-in adapter, a REST adapter or X12 278, so existing workflows can continue.
- 5Your team decidesYour utilization management system stays the place where decisions are made.
- 6Return the decisionPAS returns decisions per line, and notifies subscribers about pended requests.
System-to-system access uses SMART Backend Services, and sandbox plans support partner testing. Prismaid also publishes prior authorization data to your FHIR platform for Patient Access.
Tested against the Inferno conformance kits
Inferno results from October 2026, with conformance runs repeated weekly in our CI.
PAS
81
passed, 0 failed
CRD
104
passed, 0 failed
DTR
43
passed, 1 accepted
These are test results, not a certification. Using Prismaid doesn't by itself make a plan compliant with the rule.
One view of your readiness
Compliance cockpit
See readiness per requirement from data checks and attestations, with deadlines, alerts and conformance evidence.
Partners and endpoints
Keep partner connections in one registry, onboard them with links, and monitor endpoint health.
Setup wizard
Walk a new plan through setup, with progress detected from the data already in place.
Working toward the 2027 API date?
Tell us where your plan stands, and we will show you how Prismaid would fit.