Availity®, the nation’s 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 Authorization 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, finalized by the Centers 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 compliance1. 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 standardize data into FHIR resources and built-in support for CMS interoperability mandate compliance
• Patient Access and Provider Directory APIs: Enables 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 Authorization APIs: Enables end-to-end authorization connectivity across Availity’s vast network of delegated UM/HIT vendors, providers and health plans to fully transform the electronic prior authorization experience
• Payer-to-Payer API and Connectivity Hub: Supports sharing of clinical, claims and prior authorization 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

Meeting the Mandate: Why Interoperability Matters

The CMS-0057 regulation is a transformative step toward a more connected healthcare ecosystem. By requiring payers to adopt standardized APIs for patient access, provider access, payer-to-payer data exchange, and prior authorization, CMS aims to reduce administrative burden, improve patient outcomes, and enhance transparency across the care continuum.

“CMS-0057 is a pivotal moment for the healthcare industry,” said Mark Scrimshire, Chief Interoperability and Security Officer at Onyx. “Our partnership with Availity brings together best-in-breed capabilities across our respective platforms to enable health plans to meet these mandates with confidence—while also unlocking long-term value through automation, interoperability, and improved provider collaboration. We’re incredibly excited to collaborate with Availity to introduce this solution to the nation’s leading healthcare network.”

Moving beyond the Mandate: A Unified Platform for Seamless Compliance

The Availity-Onyx solution is designed to deliver more than just compliance—it’s built for confidence and long-term value. Key platform features include:

• Accelerated Compliance: Out-of-the-box support for all CMS interoperability mandates, ensuring fast, seamless compliance
• National Network: Eliminates costly point-to-point integrations and accelerates adoption across stakeholders
• Proven Scalability: Cloud-agnostic and FHIR-native—minimizing internal IT burden while offering flexibility to scale with evolving regulatory and business needs
• Seamless Integration: API-first architecture, SMART-on-FHIR authentication, and robust data transformation capabilities enable smooth integration
• Trusted Expertise: Deep experience in FHIR, HL7, and DaVinci workgroups, with leadership in major federal interoperability initiatives
• Robust Reporting: Real-time dashboards and CMS-compliant metrics provide actionable insights, transparency, operational oversight and continuous improvement opportunities

“We’ve built this solution to go beyond compliance,” said Sean Barrett, Chief Product Officer at Availity. “By embedding FHIR-native APIs and real-time data exchange into payer workflows, we’re laying the foundation for a more connected, efficient, and patient-centered healthcare system.”

1 CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) | CMS