Extend Your Platform to Support Prior Authorization CMS-0057-F Requirements
Deploy CMS-mandated CRD, DTR, and PAS FHIR APIs in 3–6 months — while preserving your existing utilization management workflows and decision logic.
Why choose an embedded FHIR layer
Aidbox runs alongside your existing UM platform as a Prior Authorization facade.
FHIR APIs exposed without replacing your core systems.
278 and 275 coexist with FHIR during transition.
Isolated tenant boundaries for multiple payers.
Your rules engine and case management stay as-is.
CMS-0057-F Changes the Technical Baseline
CMS-0057-F mandates fully electronic Prior Authorization workflows exposed through standardized FHIR APIs. Operational metrics, denial reason transparency, and reporting requirements are already in effect — with full API readiness required by January 1, 2027.
Standardized electronic prior authorization request and response flows.
Clear, consistent communication and SLA expectations.
Transparency and accountability for authorization performance.
Compliance burden lands on your platform; you need production-ready APIs.
The Compliance Burden Lands on Your Platform
Building a parallel FHIR-native PA intake channel from scratch introduces operational and regulatory risk.
Delegated entities face unique pressure: high prior authorization volumes, strict SLAs, and multiple intake channels.
- High PA volumes under strict SLAs
- Multiple intake channels (phone, portal, X12, FHIR)
- Integration across multiple payers
- Real-time status and decision transparency required
An Embedded FHIR Layer — Not a System Replacement
Aidbox runs alongside your existing utilization management platform as a Prior Authorization facade. It exposes CMS-compliant CRD, DTR, and PAS APIs while your internal UM platform remains the source of truth.
FHIR APIs externally. Native UM workflows internally.
No rewrite of your rules engine or case management system.
X12 and FHIR coexist during transition.
How it fits together
EHR → FHIR APIs (Aidbox) → Existing UM System → Rules Engine → Reporting. Minimal, clean, infrastructure-style.
CMS-Compliant Prior Authorization Infrastructure
Technical depth for CIO-level evaluation.
Full US Core and USCDI-aligned data model.
Da Vinci aligned; CMS-0057-F ready.
Status and decision notifications as events.
Hybrid intake during transition.
Traceability and reporting out of the box.
Isolated boundaries per payer or line of business.
Built for Multi-Payer Utilization Management
One workflow. Multiple channels. Consistent decisions.
Multi-tenant design keeps data and config separated.
Same rules whether request comes via phone, portal, X12, or FHIR.
No big-bang cutover; transition at your pace.
Your UM platform remains the source of truth.
Production-Grade CMS Infrastructure
6-month implementation with 2 customer SMEs. FHIR APIs deployed without replacing UM system.
Not pilot-only; real workloads, real SLAs.
Proven path to compliance.
Multi-payer, multi-channel from day one.
Cloud, private cloud, or hybrid.
Assess Your CMS-0057-F Architecture Readiness
Schedule a technical discussion to review your current PA landscape and define a low-risk path to FHIR compliance.
Review your current PA landscape and integration points.
Define a phased path to FHIR compliance.