CMS-0057-F is a deadline, not a project.
Four FHIR APIs. One hard date: January 1, 2027. Health1st maps your legacy claims, X12, and clinical data to US Core FHIR with AI, so your compliance program ships in weeks, not quarters.
- Patient Access · Provider Access · Payer-to-Payer · Prior Auth (PARDD)
- Built on the mandated stack: FHIR R4.0.1 + US Core STU 3.1.1 + SMART + OIDC
- AI-drafted mappings from X12 & claims, reviewed by your team
MSH|^~\&|EPIC|HOSP|H1ST|DST|202601..||ADT^A01|
PID|1||MRN12345^^^HOSP^MR||DOE^JOHN^A||
19701225|M|||123 MAIN ST^^AUSTIN^TX
PV1|1|I|ICU^101^A|||...admit...
DG1|1|I10|E11.9^Type 2 diabetes mellitusAgent
{ "resourceType": "Patient",
"identifier": [{ "value": "MRN12345" }],
"name": [{ "family": "Doe",
"given": ["John","A"] }],
"gender": "male",
"birthDate": "1970-12-25" }
{ "resourceType": "Condition",
"code": { "coding": [{
"system": ".../icd-10-cm",
"code": "E11.9" }] } }In short
A fixed deadline, legacy data, and real penalties for missing it
You know the mandate. The hard part is turning years of legacy data into conformant FHIR before the clock runs out. Procurement, security review, and an audit trail all sit on the critical path.
Four FHIR APIs, one hard deadline
CMS-0057-F requires Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization (PARDD) APIs live by January 1, 2027. That stack may not be one you run today.
Legacy claims & X12 don't speak FHIR
Your data lives in X12 837/835/278, proprietary claims warehouses, and clinical feeds. Converting all of it to US Core FHIR R4 by hand is a multi-quarter mapping project.
Prior auth is a workflow, not a form
PARDD demands automated coverage discovery, documentation requirements, and a decision loop. All of it runs inside 7-day standard / 72-hour expedited timeframes, with public PA metrics reporting.
Penalty and reputational exposure
Missing 2027 is not just a technical slip. It is audit exposure, attestation risk, and a public readiness gap your members, providers, and regulators can see.
From legacy estate to four conformant APIs
A repeatable path that puts AI on the mapping bottleneck and keeps your team in control of every clinical and claims field that ships.
- 1
Inventory & gap assessment
We map your current estate (X12 feeds, claims warehouse, clinical data, existing member APIs) against the CMS-0057-F stack (FHIR R4.0.1, US Core STU 3.1.1, SMART, Bulk Data, OIDC, USCDI) and flag every gap.
- 2
AI-drafted mappings to US Core
The Mapping Agent proposes field- and segment-level mappings from your internal models and X12 to US Core FHIR profiles, with plain-English rationale and confidence scores your team reviews.
- 3
Stand up the four APIs
Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization (PARDD), served on SMART App Launch + OIDC, with Bulk Data (Flat FHIR) for population-scale exchange.
- 4
Validate, attest & operate
Conformance-test against US Core and the Da Vinci PARDD implementation guides, capture audit trails, and monitor continuously so you stay compliant in production, not only on go-live day.
Outcomes your board and your auditors both accept
A defensible compliance program that holds up long after go-live.
Four conformant APIs, on time
Patient Access, Provider Access, Payer-to-Payer, and PARDD live on the mandated stack before January 1, 2027, validated against US Core and Da Vinci before you attest.
The mapping bottleneck, in weeks
AI drafts your X12-and-claims-to-US-Core mappings so the slowest, most expensive part of the program stops being measured in quarters.
Audit-ready from day one
Versioned, explainable mappings and immutable audit trails give compliance the evidence to defend every attestation, long after go-live.
Everything CMS-0057-F requires, on the stack it requires
FHIR R4.0.1 · US Core STU 3.1.1 · SMART App Launch 1.0.0 · Bulk Data STU 1 · OpenID Connect 1.0 · USCDI.
Patient Access API (expanded)
Members retrieve claims, encounters, clinical data, and (new under CMS-0057-F) prior authorization status via third-party apps over SMART on FHIR.
Provider Access API
In-network providers pull patient claims and clinical data (USCDI) for treatment, with attribution and opt-out handling built into the exchange.
Payer-to-Payer API
When a member moves plans, their claims and clinical history follow. Bulk FHIR exchange between prior and current payer, mapped and de-duplicated automatically.
Prior Authorization API (PARDD)
Coverage Requirements Discovery, Documentation Templates & Rules, and Prior Authorization Support: the Da Vinci PARDD stack that automates the auth decision loop.
Prior Authorization is the hardest of the four. See how Health1st automates the Da Vinci PARDD decision loop end-to-end.
Built for the people who own the mandate
CMS-0057-F lands on a specific set of desks. Health1st gives each of them what they need to say yes, and to defend the decision in an audit.
VP of Interoperability / Digital
A credible plan to reach four conformant APIs before 2027 without hiring an army of FHIR consultants.
Chief Compliance / Regulatory Officer
Auditability and conformance evidence (versioned mappings, audit trails, and honest security posture) to defend attestation.
Enterprise Architect / Head of Data
Deployment control (cloud or VPC), clean mapping of X12 and claims to US Core, and no lock-in to a pre-connected network.
Security & Compliance
Where our compliance actually stands
Protecting PHI is non-negotiable. Here's exactly where our certifications stand. No overclaiming.
Compliant · BAAs available
Audit in progress
On roadmap
Native, by design
AWS HIPAA-eligible infrastructure · Business Associate Agreements (BAAs) · Encryption in transit & at rest · See our security details →
Frequently asked questions
Get your four FHIR APIs live before January 2027.
Bring your own X12 and claims samples. We'll show a live mapping to US Core FHIR on your real message types.