Four mandated FHIR APIs, on the Da Vinci guides. Your systems stay. Your repository, your cloud. Live before January 1, 2027.
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Clinic Management Platform for patients and Doctors
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Clinic Management Platform for patients and Doctors
Digital Health Platform for medical professionals
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AI-powered personalized guide for menopause support
Patient engagement and communication platform
Clinic Management Platform for patients and Doctors
Clinic Management Platform for patients and Doctors
Digital Health Platform for medical professionals
Patient engagement and communication platform
Clinic Management Platform for patients and Doctors
Digital Health Platform for medical professionals
Escrow Management Platform for Developers and Banks
Corporate Wellness and Health Management Platform
Leading Medical Research and Healthcare Institution
Four standardised FHIR APIs, plus operational changes to how prior authorization decisions get made and reported. The rule applies to Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid and CHIP managed care plans, and QHP issuers on the federally facilitated exchanges.
A FHIR interface where a provider can discover what documentation you require, submit the request, and receive the decision electronically. Built on Da Vinci CRD, DTR and PAS. The X12 278/275 transactions you exchange today stay supported on the back end.
Expanded to carry prior authorization status alongside claims, encounters and USCDI clinical data — refreshed no later than one business day after the information changes.
Bulk FHIR access so in-network providers can pull claims, encounter, clinical and prior authorization data for their attributed patients. Requires attribution logic and a working patient opt-out.
When a member changes plans, up to five years of claims, clinical and prior authorization history moves across. Requires patient opt-in and member matching against the previous payer.
72-hour expedited and 7-day standard decisions, drugs excluded. A specific reason on every denial. Patient Access usage metrics to CMS.
Prior authorization metrics posted publicly, covering CY2025. Annually thereafter.
All four APIs operational. MA and Medicaid/CHIP FFS on the date; managed care and FFE plans on rating or plan years beginning on or after.
MIPS clinicians and hospitals begin attesting to the Electronic Prior Authorization measure.
Source: CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). Compliance dates vary by plan type — confirm applicability for your organization against the final rule. Read the full rule breakdown →
CMS-0057-F names health plans. But an API only works if the systems on both ends of it do. Three very different builds come out of the same rule.
You carry the obligation. The build is four conformant FHIR APIs sitting on top of claims, UM, eligibility, clinical and provider data that currently live in five different systems.
Scope: source-to-FHIR mapping, Da Vinci profile conformance, consent and opt-out flows, member matching, Inferno and Touchstone testing, and the metrics you're required to report.
Talk about this →Your users are the ones calling those APIs. From January 2027, prior authorization status, payer-held clinical history and five years of prior-plan data become reachable through a standard interface — if your product can consume it.
Scope: multi-payer FHIR client architecture, CRD and DTR handled inside your existing workflow, per-payer variation, and the authorization layer.
Talk about this →Your payer clients have asked for CMS-0057-F on top of a roadmap that's already full.
Scope: an embedded FHIR pod that builds the API layer inside your product, under your brand, in your repository.
Talk about this →Your core systems stay exactly where they are. The FHIR layer sits alongside them and reads from them — no migration, no replatform, no freeze on your existing roadmap.
Nothing in band one gets replaced. If a system can be read from, it can be mapped.
Nine workstreams. Most engagements need six or seven of them — the readiness assessment tells you which.
Coverage Requirements Discovery over CDS Hooks, Documentation Templates and Rules with CQL-driven questionnaires, and Prior Authorization Support wrapping the X12 278/275 you already exchange.
CARIN Blue Button for claims and encounters, US Core for clinical, PDex for prior authorization status. The one-business-day refresh enforced in the pipeline, not in a runbook.
Bulk FHIR export with attribution logic, group management, and patient opt-out honoured at query time rather than reconciled afterwards.
$member-match implementation, opt-in capture, and a five-year historical pull that reconciles duplicate records instead of stacking them.
X12 278/275, HL7 v2, C-CDA, flat files and proprietary claims schemas mapped bidirectionally to FHIR R4. We maintain the Mirth Connect Cookbook in the open; this is the day job.
SMART on FHIR, OAuth 2.0, OIDC, mTLS and UDAP-aligned dynamic client registration. Consent capture, revocation and audit at the resource level.
Inferno and Touchstone wired into CI, so profile validation runs on every merge instead of the week before attestation.
Immutable audit logs carrying decision timestamps and consent events, plus the Patient Access usage metrics and public prior authorization metrics as queryable outputs.
AWS, Azure, GCP, on-prem or hybrid. Containerised, infrastructure-as-code, handed over with runbooks. Your accounts, your repository.
You get a gap analysis across all four API domains, a source-to-FHIR mapping inventory, a risk register, a sequenced plan with effort estimates, and a build-versus-buy recommendation. If buying is the right call for you, the assessment says so.
Request The AssessmentA FHIR architect, integration engineers and QA working as one pod. Two-week sprints, a working demo at the end of each, and code in your repository from day one. No black box, no handover cliff.
Talk To A FHIR ArchitectWe audit what exists, keep what conforms, replace what doesn't, and get you to a testable endpoint. Most rescues start with a conformance run to establish what's actually true.
Send Us What ExistsTimings assume a mid-size plan or vendor with source data in three to five systems. The readiness assessment replaces this estimate with a real one.
Inventory the source systems, map claims, UM, clinical and eligibility data to FHIR resources, identify the gaps that need new data capture, and agree the deployment model.
Stand up the FHIR core, build the connectors, configure Da Vinci profiles, implement member matching, and wire consent and opt-out flows.
Inferno and Touchstone runs against every profile, end-to-end API testing, load testing, penetration testing and security review.
Production deployment, monitoring and alerting, audit log verification, and the documentation your compliance team needs on file.
Da Vinci implementation guides keep moving. We track ballot changes and ship the updates as maintenance, not as a new project.
Compliance builds have a habit of becoming write-only — data goes in to satisfy an auditor and never comes back out. Built properly, this one is a queryable clinical and claims store that everything else can sit on.
Member portals, provider-facing tools and third-party integrations run off the same FHIR store and the same auth layer. No second integration project.
Conditions, encounters and medications already structured to US Core. Flatten to tables for HCC models and HEDIS measures against the compliance store directly.
Longitudinal records — including the history that arrives through Payer-to-Payer — feed care coordination, utilization management and population health without a new pipeline.
Structured FHIR is what ML pipelines want. Prior authorization auto-decisioning, predictive models, NLP over clinical notes — all against a single source.
The attribution and export machinery built for Provider Access is the same machinery value-based care reporting and network analytics need.
New Da Vinci guides, digital quality measures, TEFCA-aligned exchange. These land as configuration on infrastructure you already run.
FHIR R4 architecture, Da Vinci profile work, X12 and HL7 mapping — the layers CMS-0057-F sits on. Much of it is in public repositories, so you can read the code before you talk to us.
28 clinical domains, 70+ FHIR R4 resources, SMART on FHIR, schema-per-tenant multi-tenancy and HIPAA audit logging. Public repository, public commit history.
View on GitHub →OpenMirth Console — an operations and observability layer for Mirth Connect — plus a cookbook of production channel templates, transformers and filters we maintain publicly.
View on GitHub →One healthtech went from no FHIR capability at all to a working Epic integration in five weeks.
A health data platform integrating Epic, Cerner, Allscripts and athenahealth behind one interface — the same per-vendor variation problem CMS-0057-F creates across payers.
HIPAA-compliant · SOC 2 Type II · ISO 27001 certified · FHIR R4 native · We sign Business Associate Agreements with US health systems and digital health customers.
Send us your system landscape — claims platform, UM tool, clinical data sources, and whatever is already FHIR. We'll come back with the gap list across all four API domains and a sequenced plan. No deck required, and no obligation to build with us afterwards.
A FHIR architect will come back to you within one business day.
Healthcare-only software engineering. FHIR R4 native, Da Vinci conformant, and building nothing outside this industry.
Security & standards
HL7® and FHIR® are registered trademarks of Health Level Seven International. CMS-0057-F is a regulation of the U.S. Centers for Medicare & Medicaid Services. Nirmitee.io is not affiliated with, or endorsed by, HL7 International or CMS.
