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CMS-0057-F Interoperability Suite for Payers

Move beyond compliance to scalable, real world interoperability—powered by the Availity Network.

The Centers for Medicare & Medicaid Services Interoperability & Prior Authorization Final Rule (CMS-0057-F) establishes a baseline for interoperability by requiring payers to make data available through Fast Healthcare Interoperability Resources (FHIR®) APIs. But standing up APIs alone doesn’t deliver meaningful value. 

Point-to-point integrations are costly to build, difficult to maintain, and nearly impossible to scale. Teams spend more time managing connections than improving clinical and operational performance. 

Availity delivers everything CMS-0057-F requires—and the network connectivity to make it work in practice. Our end-to-end interoperability suite combines compliant FHIR APIs, workflow automation, and data orchestration on a trusted national network, enabling payers to scale interoperability, accelerate adoption, and realize measurable value beyond compliance. 

Get the CMS-0057-F Blueprint

End-to-End Interoperability, Built for Scale

An End-to-End CMS-0057-F Solution—Built on a Live Network

Availity connects your APIs, workflows, and partners through a single interoperability framework—reducing fragmentation while accelerating adoption across providers and payers. 

  • FHIR Server Management 
    Secure, flexible FHIR infrastructure with built-in data transformation and CMS-0057-F compliance. 
  • Prior Authorization APIs & Connectivity Hub 
    End-to-end connectivity that modernizes authorization workflows at scale. 
  • Provider Access APIs & Connectivity Hub 
    Mandate ready access to patient data with standardized provider onboarding. 
  • Payer-to-Payer APIs & Connectivity Hub 
    One-to-many payer data exchange aligned to CMS-0057-F requirements. 
  • Patient Access & Provider Directory APIs 
    Secure member access and directory services via FHIR APIs. 

APIs Alone Don’t Create Interoperability

APIs Enable Compliance. Networks Unlock Value.

Building compliant FHIR APIs checks the regulatory box—but compliance alone delivers limited return. Interoperability creates value only when APIs are activated through network connectivity. 

When data moves reliably across organizations; workflows evolve, and insights become actionable at scale. 

  • Faster provider adoption 
  • Richer clinical context 
  • Reduced onboarding friction 
  • Real-world transaction volume 
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Our Connectivity Hubs

Use Cases Powered by Availity Clinical Data Solutions

Prior Authorization Connectivity Hub

CMS-0057-F compliant connectivity between providers, partners, and your CRD/DTR/PAS APIs. 

What it does

Provides a secure, standardized onramp between providers, partners, and your CRD/DTR/PAS APIs—enabling CMS-0057-Fcompliant prior authorization at scale. 

Key capabilities
  • Routes FHIR bundles once to multiple CRD/DTR/PAS endpoints 
  • Supports DTR via SMART on FHIR to drive provider adoption 
  • Eliminates one-off EHR integrations 
Value
  • Accelerate provider onboarding through Availity’s national network 
  • Lower integration and ongoing maintenance costs 
  • Maintain full control of clinical logic and governance 

Prior Authorization Coordinator & Translation 

Orchestrate, normalize, and scale utilization management workflows. 

What it does

Absorbs orchestration, normalization, and enrichment complexity—allowing payers to modernize utilization management while reducing operational burden.

Key capabilities
  • Routes and coordinates FHIR bundles across internal and external systems 
  • Normalizes data variations across vendors and delegated entities 
  • Supports seamless handoffs across UM workflows 
Value
  • Evolve UM operating models without reengineering integrations 
  • Reduce longterm integration and maintenance costs 
  • Adapt quickly to regulatory and clinical changes 

Provider Access Connectivity Hub 

Secure, standardized provider access to patient data under CMS-0057-F. 

What it does

Enables secure, CMS-0057-F compliant provider access to patientspecific data through a single, standardized entry point. 

Key capabilities
  • Routes provider requests to your Provider Access API 
  • Supports multiple authentication pathways 
  • Enables secure, patientspecific FHIR data retrieval 
  • Monitors API performance and access issues 
Value
  • Shorten provider onboarding timelines 
  • Reduce manual validation and authentication effort 
  • Improve provider experience without compromising security 

Payer-to-Payer Connectivity Hub 

One-to-many payer data exchange at real world scale. 

What it does

Provides a standardized gateway for exchanging clinical, claims, and authorization data between health plans—supporting CMS-0057-F at real-world scale. 

Key capabilities
  • Manages inbound and outbound payertopayer FHIR requests 
  • Enables onetomany connectivity across payers 
  • Works with Availitybuilt or existing payer APIs 
Value
  • Eliminate pointtopoint payer integrations 
  • Increase successful payertopayer exchanges 
  • Identify and manage new member populations without manual coordination 

Built to Solve Connectivity at Scale

Connected
Providers

Direct Payer
Connectivity

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B2B Partners

Billed Claims
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US Healthcare
Transactions

FAQS:

What is CMS‑0057‑F?

CMS‑0057‑F is the CMS Interoperability and Prior Authorization Final Rule that requires payers to support standardized FHIR APIs for prior authorization, provider access, patient access, and payer‑to‑payer data exchange.

How does Availity support CMS-0057-F compliance?

Availity delivers a compliance‑ready CMS-0057-F solution anchored in network connectivity, combining FHIR‑based APIs with connectivity hubs that enable data exchange at scale across payers and providers.

Do payers still need to build their own APIs?

Yes. Many payers choose to build or partner (including with Availity) on their own APIs. Availity complements those APIs by providing the connectivity, routing, onboarding, monitoring, and operational support required to make them work in the real world.

Why isn’t building compliant APIs enough?

APIs alone don’t ensure adoption. CMS-0057-F success depends on many‑to‑many connectivity, provider onboarding, standardized routing, performance monitoring, and ongoing support—capabilities delivered through Availity’s national network.

How does Availity support Prior Authorization under CMS-0057-F?

Availity supports CMS-0057-F prior authorization through Da Vinci–aligned CRD, DTR, and PAS workflows, paired with network connectivity that standardizes how requests flow across providers, EHRs, and payer systems.

How does Availity support Provider Access APIs?

Availity enables CMS-0057-F compliant Provider Access by providing a Provider Connectivity Hub that supports authentication, routing, monitoring, and high‑volume provider access to patient‑specific data.

How does Availity support Payer‑to‑Payer exchange?

Availity provides a one‑to‑many Payer‑to‑Payer Connectivity Hub, reducing point‑to‑point integrations and enabling secure, scalable data exchange between health plans under CMS-0057-F requirements.

We’re stuck on CMS-0057-F and unsure how to move forward. How does Availity help?

CMS-0057-F can feel overwhelming without a clear path. Availity helps payers move from uncertainty to execution by combining regulatory guidance, proven connectivity models, and a practical roadmap for standing up compliant, scalable interoperability.

Check out our CMS-0057-F Blueprint for more information here

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