CMS-0057-F made FHIR the public-facing surface for Prior Authorization, but inside almost every US health plan, the back office still speaks X12. The 278 request and 275 attachment formats are deeply embedded in UM systems, EDI pipelines...
Prior Authorization
Top 6 SMART App Launch Tools for ePA Inside the EHR
The Documentation Templates and Rules (DTR) component of Da Vinci ePA lives or dies on the SMART App Launch experience inside the provider EHR. The provider does not pause to log into a payer portal; the DTR SMART app has to launch in co...
Prior Authorization
Top 5 Da Vinci PAS Implementation Tools for 2026
The Da Vinci PAS implementation guide has been around since 2021, but 2026 is when health plans are actually shipping it, not just demoing it. With the CMS-0057-F production deadline at January 1, 2027, vendor selection is happening fast...
Prior Authorization
Top 5 CQL Engines for Medical Necessity Decisions in Prior Auth
Clinical Quality Language (CQL) is the layer doing the actual work behind FHIR-based Prior Authorization medical necessity checks. The Da Vinci CRD specification depends on CQL for evaluating coverage rules at order time; the DTR specifi...
Prior Authorization
The Complete Guide to FHIR Prior Authorization for Health Plans in 2026
CMS-0057-F turned Prior Authorization from a back-office workflow into a regulated API surface. Health plans that signed CMS-9115-F contracts in 2021 are discovering, often late in 2026, that the Prior Auth API requirement under 0057-F i...
Prior Authorization
Da Vinci PAS vs Legacy X12 278: How to Choose for CMS-0057-F
CMS-0057-F added Da Vinci PAS as a required Prior Authorization API, but it did not retire X12 278 / 275. Both will live side by side inside US health plans through 2027 and beyond. The strategic question for a payer in 2026 is not "FHIR...
Prior Authorization
CDS Hooks vs Direct REST for Da Vinci CRD: A Practical Comparison
Da Vinci Coverage Requirements Discovery (CRD) can be wired into the provider workflow two ways. The CDS Hooks pattern fires a service call at a specific decision point inside the EHR (order-sign, appointment-book, medication-prescribe)....
Prior Authorization
Best FHIR Solutions for 72-Hour Prior Auth Decision SLAs
The 72-hour expedited and 7-day standard decision SLAs in CMS-0057-F took effect on January 1, 2026, before the rest of the API requirements. That order is intentional. CMS wanted the operational discipline in place before the public-fac...
Prior Authorization
Best CRD DTR PAS Platforms for ePA Workflows in 2026
Most ePA platform marketing collapses three Da Vinci pillars into one bullet point. The reality is that Coverage Requirements Discovery (CRD), Documentation Templates and Rules (DTR), and Prior Authorization Support (PAS) are three separ...
Prior Authorization
5 FHIR Subscription Engines for Real-Time Prior Auth Decisions
CMS-0057-F requires that Prior Authorization decisions reach the Patient Access API within one business day of the determination. In practice, "within one business day" is implemented as "near-real-time" via FHIR Subscriptions, because b...