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Health Intelligence USA Series: CMS-0057-F: The 72-Hour 'Death Clock' & The End of the Fax Machine - By DjamgaMind
Season 31 Episode 31
Guest Host: DjamgaMind Intelligence
Episode Summary: We decode the 847-page CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This rule mandates the use of HL7 FHIR APIs and sets strict timelines for prior authorization decisions.
Key Intelligence Points:
- The "Death Clock": Payers must decide on expedited prior auth requests within 72 hours and standard requests within 7 days.
- The API Mandate: Implementation of the Patient Access API, Provider Access API, and Payer-to-Payer API.
- Public Shame: The requirement to publicly report denial rates and decision timeframes on your website.
- Compliance Deadlines: What needs to be built by 2026 and 2027.
Source Document: CMS-0057-F Full Text: https://www.cms.gov/files/document/cms-0057-f.pdf
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Published on 19 hours ago