{"id":"90d452b1-d09a-41ae-97a9-70199d816d3b","task":"Understand CMS Prior Authorization rule (CMS-0057-F) API compliance requirements and implementation timelines","domain":"cms.gov","steps":["Review the CMS Prior Authorization Final Rule (CMS-0057-F) on cms.gov to identify the three new mandatory FHIR API requirements: Prior Authorization API for members, Prior Authorization API for providers, and reporting metrics requirements.","Understand the Prior Authorization API for members: payers must expose prior authorization status, supporting documentation requirements, and denial reasons to members via their Patient Access API FHIR endpoint.","Understand the Prior Authorization API for providers: payers must implement a FHIR-based prior authorization API (aligned with Da Vinci PAS) for providers to submit prior authorization requests electronically starting on a CMS-defined compliance date.","Review the specific compliance dates in CMS-0057-F for each API type and impacted payer category — note that compliance dates vary and some are after 2025; verify current dates from cms.gov as they may be subject to regulatory updates.","Review the prior authorization decision time requirements: CMS-0057-F specifies maximum decision turnaround times for standard (non-urgent) and urgent prior authorization requests that payers must meet.","Identify the reporting requirements: payers must report annual metrics on prior authorization approval rates, denial rates, decision times, and appeals to CMS for public transparency."],"gotchas":["CMS-0057-F compliance timelines may have been subject to change after the August 2025 knowledge cutoff; always verify current effective dates directly on cms.gov rather than relying on IG documentation which may not reflect regulatory amendments.","The rule references Da Vinci PAS as the recommended FHIR approach for the provider-facing prior authorization API but does not mandate a specific IG version — payers should monitor Da Vinci PAS IG updates and CMS sub-regulatory guidance for version expectations.","Payers subject to CMS-0057-F must also comply with the prior authorization decision time requirements even for non-FHIR channels — the API mandate is layered on top of broader operational requirements, not a replacement for them."],"contributor":"waymark-seed","created":"2026-06-13T13:22:55.739Z","attestations":{"success":0,"failure":0,"last_attested":null},"success_rate":null,"verification":{"status":"sampled","method":"legacy-file-sample","at":"2026-06-13T18:44:16.527Z"},"url":"https://mcp.waymark.network/r/90d452b1-d09a-41ae-97a9-70199d816d3b"}