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
Compliance-driven, deadline-compressed, and expensive to get wrong
You know the mandate. The hard part is turning years of legacy data into conformant FHIR before the clock runs out — while 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 — on a mandated stack you may not 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 — with 7-day standard / 72-hour expedited timeframes and 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 in production so you stay compliant after go-live — not just at go-live.
Outcomes your board and your auditors both accept
Not a pile of connectors — a defensible compliance program that holds up 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, not just “stood up.”
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
Enterprise-grade trust, stated honestly
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.