The CMS clock is your roadmap. We keep you ahead of it.
Prior-auth automation, member engagement, and CMS-0057-F interoperability, delivered by operators who sit on both sides of the payer-provider table.
Six ways in. One integrated partner.
Prior-Auth Automation
Da Vinci ePA APIs operational by January 1, 2027, with agentic evidence assembly, human-in-the-loop review, and AIGaaS governance.
Interoperability + Rosetta
Payer Prior Auth and Provider Access APIs on semantic rails, so CMS-0057-F readiness goes past checkbox FHIR.
AI Governance for UM
Utilization-management AI with drift detection, bias monitoring, and explainability reporting, ready for regulator review.
Data & Analytics
Risk adjustment, quality measures, and member-churn modeling on governed data infrastructure.
Digital Member Engagement
Omnichannel outreach and self-service built into the member workflow itself.
Regulatory & Compliance
HIPAA, NIST CSF, and CMS mandate tracking as a continuous practice with quarterly evidence reviews.
Four obligations, one deadline.
Impacted payers must have Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs operational by January 1, 2027. We scope against the rule text, not a vendor roadmap.
Prior Authorization API
Da Vinci ePA implementation with decision reasons and status returned in the format the rule requires.
Provider Access API
Claims, encounter, and clinical data exposure to contracted providers, with attribution and consent handled.
Payer-to-Payer exchange
Member data portability at enrollment, including the five-year historical window.
Metrics and reporting
The public reporting obligations that follow each API, instrumented before the first submission.
Schedule your CMS-0057-F readiness assessment.
Review API architecture, Da Vinci ePA alignment, and timeline with our payer specialists.