← All glossary termsCMS-0057-F (Interoperability and Prior Authorization Final Rule)
The CMS rule requiring impacted payers (Medicare Advantage, Medicaid, CHIP, QHP issuers) to meet specific prior auth turnaround times, support FHIR-based electronic PA, and publicly report denial rate metrics.
What it means
This rule took effect January 1, 2026 for decision timelines and public reporting requirements, with the full FHIR API mandate following on January 1, 2027. It's the primary regulatory driver behind the industry's shift to electronic prior authorization, and understanding its specific deadlines (rather than treating it as one blanket requirement) matters for accurate positioning.
