Insights, guides, and engineering stories from the frontlines of healthcare technology.
In brief: CMS does not certify payer APIs; payers attest. Readiness is shown with an evidence pack: Inferno test-kit reports, end-to-end runs on publi...
In brief: A payer building the four CMS-0057-F APIs is building six shared layers: a FHIR data plane, identity and trust, matching and consent, bulk e...
In brief: Prior Authorization Support is the Da Vinci guide that carries the request. A FHIR Claim bundle goes to Claim/$submit ; the payer answers qu...
In brief: Documentation Templates and Rules is the Da Vinci guide that delivers a payer's questionnaire together with CQL logic that pre-fills it from...
In brief: Coverage Requirements Discovery is the Da Vinci guide that lets an EHR ask a payer, at the moment an order is signed, whether the service is...
In brief: CMS-0057-F obliges Medicare Advantage, Medicaid and CHIP, and federal-exchange plans to decide prior authorization requests within 72 hours ...
CMS-0057-F set the current obligations. A follow-on proposed rule, CMS-0062-P, would change three things that materially affect how payers should plan...
Ask payers what is holding up CMS-0057 and the answer is rarely FHIR. It is that a large share of the data the rule requires them to serve does not si...
Most payers built a Patient Access API years ago under CMS-9115. It is live, it returns valid FHIR, and it passes a smoke test. The uncomfortable find...
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