What is CMS-0057-F Prior Authorization?

CMS-0057-F is a federal rule requiring payers to implement a Prior Authorization API using FHIR by January 1, 2027. It mandates electronic processing of X12 278 Prior Authorization requests via FHIR-based APIs compliant with the Da Vinci PAS Implementation Guide.

How does Redix support X12 278 to FHIR conversion?

Redix provides bidirectional conversion between X12 278 Request/Response and FHIR Claim/ClaimResponse resources, supporting both the request and response workflows required for CMS PAS compliance.

What is the Da Vinci PAS Implementation Guide?

The Da Vinci Prior Authorization Support (PAS) Implementation Guide defines the FHIR-based API specification for electronic prior authorization. It maps X12 278 transactions to FHIR resources, enabling real-time prior authorization processing.

How do CRD, DTR, and PAS work together for ePA certification?

CRD (Coverage Requirements Discovery) checks at the point of order entry whether prior authorization is required. DTR (Documentation Templates and Rules) presents payer-specific questionnaires via a SMART-on-FHIR app, auto-populating answers from the patient record. PAS (Prior Authorization Support) submits the completed request electronically via FHIR. Together they form the ONC ePA certification triad, replacing manual fax and portal workflows with real-time electronic prior authorization.

Bidirectional X12 278 ↔ Da Vinci PAS FHIR Conversion

Achieve FHIR prior authorization compliance without abandoning your legacy X12 and UM infrastructure.

278 Request 278 Response Da Vinci PAS CMS-0057-F CRD DTR ONC ePA

Validated against Da Vinci PAS 2.0.1 & 2.1.0 profiles — 0 errors

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Professional 278 prior authorization (de-identified example) — run any of the four conversions:

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About CMS Prior Authorization (Da Vinci PAS)

Test CMS-0057-F Prior Authorization compliance using the Da Vinci PAS Implementation Guide. Convert X12 278 Request and Response transactions to FHIR R4, or convert FHIR Prior Authorization resources to RMap format. This tool supports both directions of the prior authorization workflow required for CMS payer compliance by January 1, 2027.

The ePA Ecosystem: CRD + DTR + PAS

Beginning in October 2025, ONC ePA certification criteria require health IT systems to support three interconnected Da Vinci implementation guides that together enable fully electronic prior authorization:

Coverage Requirements Discovery (CRD) — Embedded in the EHR workflow, CRD queries the payer in real-time at the point of order entry to determine whether prior authorization is required and what documentation is needed.
Documentation Templates and Rules (DTR) — When CRD indicates documentation is required, DTR launches a SMART-on-FHIR app that presents payer-specific questionnaires, auto-populating answers from the patient record to reduce manual data entry.
Prior Authorization Support (PAS) — Once documentation is complete, PAS submits the prior authorization request electronically via FHIR, replacing fax and portal-based workflows with real-time or near-real-time decisions.

Together, this triad eliminates the manual burden of prior authorization. AHIP and major payers have committed to industry-wide electronic prior authorization adoption by the CMS January 2027 deadline. Explore the full CMS-0057-F Compliance Suite →