The Workgroup for Electronic Data Interchange launched a free directory for organizations seeking testing partners for the CMS Advancing Interoperability and Improving Prior Authorization Final Rule (CMS-0057-F), in advance of the Jan. 1, 2027, compliance deadline. WEDI encouraged all organizations impacted by the rule to post their information on the directory and use it to test APIs with eligible partners.
CMS-0057-F requires entities to implement certain HL7 FHIR APIs: Prior Authorization, Payer-to-Payer, Patient Access and Provider Access. The Prior Authorization API can identify documentation requirements for prior authorization approval, while the Payer-to-Payer API enables the exchange of claims and encounter data. The Patient Access API allows patients to access their health information, and the Provider Access API allows payers to share patient data with in-network providers.
Overall, the rule aims to streamline prior authorization requests and responses and reduce burdens on providers, payers and patients. When finalized in 2024, CMS estimated that the rule would save approximately $15 billion over the next 10 years.
However, an April 2025 survey by WEDI found that providers and payers were struggling to implement the required FHIR APIs. At the time, more than half of providers reported not having started work on the API requirements, citing insufficient funding and challenges in establishing a cohesive interoperability strategy.
Nearly 45% of payers had not started work on the API requirements as of April 2025, citing difficulties with digitizing prior authorization policies, obtaining funding and determining an enterprise interoperability strategy.
Now, organizations are looking to test with other organizations in preparation for the upcoming deadline.
"It is critical that organizations test with their partners to ensure readiness to meet the CMS-0057-F API requirements by January 1, 2027. Successful testing will demonstrate to payers, providers, vendors—and most importantly, patients—the value of these APIs and the real-time data exchange they enable," WEDI Executive Director Robert Tennant stated in the directory announcement.
"WEDI is here to support the industry through our testing directory, education, and other resources to help meet this critical compliance challenge. We are pleased to serve as a facilitator to connect stakeholders and accelerate interoperability."
Organizations that want to test can complete a questionnaire that includes contact information, specific APIs available for testing and a link to their website. Organizations can also look for testing partners using the directory and contact the organizations they want to test with. The directory will display summaries of completed testing.
At the time of publication, six entities had posted their information on the directory: Wellmark, Mayo Clinic, Veradigm, Blue Cross Blue Shield of Michigan, NextGen Healthcare and ZeOmega.
Jill Hughes has covered health tech news since 2021.
