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Prior Authorization and Interoperability

The Interoperability and Prior Authorization final rule, CMS-0057-F, is a significant step on the road to true interoperability between payers, providers, and patients. The new rule gives healthcare organizations an opportunity—and an obligation—to improve the patient experience, reduce administrative burdens, and create new operational efficiencies.

With nearly three decades of experience in healthcare data interoperability and compliance, the Edifecs’ interoperability platform includes the technology required to enable compliance with CMS-0057-F. Our FHIR and EDI capabilities offer a robust solution that addresses all aspects of the mandate, including APIs for Prior Authorization, Patient and Provider Access, and Payer-to-Payer data exchange. We have been named Best in KLAS for CMS Payer Interoperability for two years in a row and support leading health plans, CMS, and government agencies nationwide. Our solutions give your organization the tools you need to seamlessly exchange data while meeting FHIR® standards to ensure ongoing compliance with CMS requirements.

Build a Better Healthcare Ecosystem

We have the tools and expertise to help you comply with CMS-0057-F requirements.

FHIR Edifecs 3
  • Create, manage, and integrate Medical Guidelines
  • Automate approval rules with standards-based tools
  • Access reporting on performance against CMS-0057 metrics

Simplify prior authorization workflows

Deliver a faster and more streamlined experience for partners and members.

Healthcare Interoperability 1
  • Effectively exchange data, no matter the scale or complexity
  • Satisfy requirements for Prior Authorization, Patient and Provider Access APIs, and Payer-to-Payer data exchange APIs
  • Enable continuous performance with SaaS and on-premises support

Enhance data exchange capabilities

Ensure seamless data standardization and exchange through our FHIR and EDI unified gateway.

Patient Data Management 2
  • Improve the way data is managed, cleansed, enriched, and shared
  • Gain flexibility with SaaS, on-premises, or hybrid deployment
  • Enable data compliance with HIPAA, FHIR®, HL7, and other standards

Harness complex healthcare data

Improve the effectiveness of data exchange across the healthcare spectrum.

News & Insights

Preparing for CMS-0057-F Interoperability and Prior Authorization Rule
Preparing for CMS-0057-F Interoperability and Prior Authorization Rule
CMS-0057-F, the prior authorization and interoperability rule, is now final. Edifecs explains what it means and what you need to do to comply.
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Automated Prior Authorization Technologies Blog
Solving for Automated Prior Authorization: Three Things You Need to Know
Learn how to solve for real-time prior authorization and evolving legislation.
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Edifecs Tops Best in KLAS for CMS Payer Interoperability Category for the Second Year in a Row
Edifecs interoperability solutions enable compliance with CMS Interoperability and Prior Authorization Final Rule
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