Healthcare Interoperability
FHIR, X12 and CMS-0057-F prior authorization: we design, build and run the exchanges between providers, payers and CMS — and we have shown it working end to end.
About this service
CMS now requires payers to answer prior-authorization requests within 72 hours for urgent care and 7 days otherwise, and to run FHIR APIs for patients, providers, other payers and prior authorization from January 2027. We build those systems: Da Vinci CRD, DTR and PAS on FHIR R4, the payer's rules running as CQL or FHIRPath against the chart, X12 278 and claims flows alongside, and the AWS platform underneath. Our Prior Authorization Workbench runs the whole flow — routine, urgent, denied and appealed — and the recordings below show it.
See it working
We built a FHIR Prior Authorization Workbench to the Da Vinci guides and CMS-0057-F, and recorded it end to end: a routine request, an urgent one on the 72-hour clock, a denial taken to appeal, and all six CRD hooks in one visit. Synthetic patients only.
Part 1 — FHIR prior authorization, end to end
CRD → DTR → PAS → CDex on a live system: the order, the payer's rules running as CQL, the pre-filled form, the decision.
Watch on YouTube →
Part 2 — Urgent requests and the 72-hour clock
Expedited prior auth under CMS-0057-F: priority stat in PAS, a queue sorted by deadline.
Watch on YouTube →
Part 3 — Denials and appeals
A specific denial reason, an appeal as a FHIR Task, a Medical Director review, and an overturn.
Watch on YouTube →
Part 4 — All six Da Vinci CRD hooks in one visit
One patient end to end: every CDS Hooks moment from scheduling to discharge, and the later hooks finding the authorization on file.
Watch on YouTube →
Standards we work in
FHIR
Da Vinci
CMS
X12 5010 (HIPAA)
Logic and terminology
Working on a CMS program?
We run the Workbench live with your scenarios, and scope proofs of concept for payers, CMS contractors and their primes.
Request a live demoThe full Healthcare Interoperability guide is for clients
Sign in or create a free account to read the complete guide: approach, worked examples and implementation detail.
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