Availity, the largest real-time health information network, and Onyx, a leader in FHIR-based interoperability, have partnered to deliver a comprehensive, out-of-the-box solution to help health plans meet the requirements of the CMS-0057 Interoperability and Prior Authorisation Final Rule. The joint platform is designed to simplify compliance, reduce administrative burden, and future-proof payer infrastructure for evolving regulatory and operational needs.
The CMS-0057 rule, finalised by the Centres for Medicare & Medicaid Services (CMS), mandates that impacted payers implement a suite of APIs and reporting capabilities by January 1, 2027. CMS estimates a 30-month timeline for implementation and testing to meet full compliance. With less than 18 months away from compliance deadlines, health plans are facing challenging implementation timelines. Backed by a team with deep interoperability expertise that helped define the industry standard and a national payer-provider-vendor network, The Availity-Onyx solution delivers a proven, scalable path to help health plans not only meet compliance but effectively drive value and ROI via scaled FHIR interoperability. Solution capabilities include:
FHIR server management: Flexible, secure and cloud-agnostic FHIR operating system with a robust data transformation layer to standardise data into FHIR resources and built-in support for CMS interoperability mandate compliance
Patient Access and Provider Directory APIs: Enable members' access to claims, encounters, and clinical data via mandated FHIR APIs, conforming to the CARIN IG for Blue Button and also including a developer portal and app store for third-party integrations
Prior Authorisation APIs: Enable end-to-end authorisation connectivity across Availity’s vast network of delegated UM/HIT vendors, providers and health plans to fully transform the electronic prior authorisation experience
Payer-to-Payer API and Connectivity Hub: Supports sharing of clinical, claims and prior authorisation data and facilitates secure, real-time data exchange between health plans and across the Availity Payer-to-Payer Connectivity Hub
Provider Access API and Connectivity Hub: Enables mandate compliance, allowing providers to retrieve patient-specific data securely and efficiently, directly from the health plan and via Availity’s Provider Connectivity Hub
