What is CMS-0057-F Prior Authorization?

CMS-0057-F is a federal rule requiring impacted payers (Medicare Advantage, Medicaid and CHIP programs and plans, and federal-exchange plans) to implement a FHIR Prior Authorization API by January 1, 2027. CMS recommends the HL7 Da Vinci CRD, DTR and PAS implementation guides for that API.

How does Redix support X12 278 to FHIR conversion?

Redix converts X12 278 Requests and Responses to Da Vinci PAS FHIR Claim and ClaimResponse resources. The reverse FHIR to X12 278 direction is in development.

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?

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 are designed to support electronic prior authorization in place of manual fax and portal workflows.

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 ePA

Reference samples validate against Da Vinci PAS 2.0.1 & 2.1.0 profiles. Each conversion reports its own checks below.

Try a Sample

Professional 278 prior authorization (de-identified example). Primary conversions:

Developer examples — legacy RMap path (FHIR → RMap two-step; not the new response contract):

Built on the native Redix conversion engine. Designed for high-throughput payer integration workflows.

Upload File
Paste Content

Drop X12 278 file here or click to browse

Only X12 278 Request or 278 Response files (max 50KB)

Paste X12 278 Content: 0 characters (max 51,200 for 50KB limit)

Evaluation New request converter under controlled live evaluation. Use synthetic / de-identified data only.

Both methods use the same Redix conversion engine (FHIR → RMap → X12 278, in one step). Choose how your FHIR reaches the Redix contract.

During evaluation, conversion runs the reviewed demo samples; other uploads can be inspected with Review FHIR adaptation but are not converted until validation completeness is finalized.

Input method

Your input must conform to the Redix contract. Download the versioned contract

Upload File
Paste Content

Drop a FHIR Bundle (JSON) here or click to browse

Upload your own FHIR file (max 50KB). Uploading and converting your own data requires your API key.

FHIR bundle (JSON):

include RMap (technical view)

Conversion Complete

Type

Direction

Resources/Records

Input Size

Output Size

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About CMS Prior Authorization (Da Vinci PAS)

Explore the HL7 Da Vinci PAS Implementation Guide with synthetic data. Convert X12 278 Request and Response transactions to FHIR R4. A legacy developer path (FHIR → RMap two-step) is also available. The reverse FHIR to X12 278 direction is in development.

The ePA Ecosystem: CRD + DTR + PAS

CRD, DTR and PAS are three HL7 Da Vinci implementation guides designed to work together for 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, these three guides are designed to reduce manual prior authorization work by bringing requirement checks, documentation and submission into the provider’s workflow. Explore the Prior Authorization Workflow and API Sandbox →