Availity Launches CMS-0057-F Blueprint to Help Health Plans Operationalize Compliance at Scale
JACKSONVILLE, Fla.--( BUSINESS WIRE)-- Availity ®, the nation’s largest health information network, reinforced its preparedness for the Centers for Medicare and Medicaid Interoperability and Prior Authorization Final Rule (CMS-0057-F) and unveiled a Blueprint for health plans to help ensure readiness and operationalize compliant APIs at scale before the Jan. 1, 2027 deadline.
"CMS-0057-F is a business opportunity for health plans to improve patient and provider experience if they use this time to evaluate how the increased data exchange can support enhanced workflows and increased collaboration"
"CMS-0057-F is a business opportunity for health plans to improve patient and provider experience if they use this time to evaluate how the increased data exchange can support enhanced workflows and increased collaboration,” said Chris Kenyon, Director of Clinical Solutions at Availity. “Plans will not realize the true value of these APIs if they only focus on developing and maintaining the network infrastructure, which other companies have spent years building and securing. We created this Blueprint to outline a thought process plans can use to assist in assessing their business readiness and chart a path to value creation while also providing questions to use to help evaluate the myriad partners required to succeed.”
What is CMS-0057-F and its goal? CMS-0057-F requires payers to implement a suite of APIs and reporting capabilities for patient and provider access, payer-to-payer data exchange, and prior authorization. This requirement aims to reduce administrative burden, improve patient outcomes, and enhance transparency.
Are companies able to meet CMS-0057-F requirements individually? Organizations are realizing the complexity of establishing the quantity of API connections needed to be CMS compliant.
How can CMS-0057-F APIs deliver true value? CMS-0057-F encourages modernization of how organizations incorporate data into workflows to streamline operations, reduce waste, and support patients. With compliant APIs, organizations can reduce reliance on manual data exchange, vendors, and chart chasing, while improving quality and Star Ratings. However, to realize the full value of CMS-0057-F, companies need to do more than simply implement APIs as written.
Has Availity confirmed connectivity? Availity has built and operates a network that is compliant with CMS-0057-F requirements. Availity provides the trusted, secure network the industry runs on. This infrastructure manages identity, trust, routing, onboarding, and workflow activation at a national scale. For CMS-0057-F requirements, Availity has set up direct connections through our network that currently represent more than 25% of all payers nationally.
How has Availity prepared for CMS-0057-F and what resources are available to evaluate readiness? As adoption accelerates, many organizations are discovering the operational complexity of establishing and maintaining the volume of API connections required to meet CMS-0057-F at scale.
Availity released a Blueprint that outlines steps organizations can take to help achieve compliance, including:
To help operationalize CMS-0057-F at your organization, download Availity’s CMS-0057-F Blueprint.
About Availity
Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation's largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn.