CMS-0057-F prior authorization without replacing your X12 backend
Redix converts existing X12 278 prior authorization transactions to FHIR R4 / Da Vinci PAS, so payers, TPAs, clearinghouses, and processors can add the FHIR side alongside their current transaction stack. Connecting to your systems depends on your interfaces and is scoped with you.
- X12 278 → FHIR PAS
- Da Vinci PAS
- RMap option
- On-premises or Docker
Timing. CMS-0057-F API requirements generally begin January 1, 2027, for impacted payers; timing depends on payer category. Operational provisions took effect in 2026.
CMS-PAS docs: Overview · Architecture · Test Workflow · Compatibility Matrix · API Reference. Not a covered entity but inheriting PAS traffic? See Handling PAS traffic without changing your backend.
Payers, providers, clearinghouses, and platform vendors
Health plans
Medicare Advantage organizations, Medicaid and CHIP programs and managed care plans, and QHP issuers on the Federally-facilitated Exchanges: the payers CMS-0057-F applies to.
Providers and health systems
Organizations integrating prior-authorization workflows into EHR/RCM and provider access APIs.
TPAs and clearinghouses
Organizations processing prior authorization on behalf of health plans.
Platform vendors
EHR, RCM, and integration vendors adding CMS-0057-F prior authorization to their stack.
Available today, demonstrated, and scoped per customer
X12 278 to FHIR conversion is available today; CRD, DTR, and PAS workflows are shown as demonstrations; connecting to your systems is implementation work scoped per customer.
Prior Authorization API and supporting API demonstrations
- Prior Authorization API: PAS $submit and $inquire with simulated decisions (demonstrated)
- Patient Access API workflow (demonstrated on sample data)
- Provider Access API workflow (demonstrated on sample data)
- Payer-to-Payer API workflow (demonstrated on sample data)
- Production integration scoped per customer
Da Vinci IG support
- Da Vinci PAS ($submit and $inquire; updates and cancellations go through $submit, as the guide defines)
- CRD (coverage requirements discovery): demonstrated scenario
- DTR (documentation templates and rules): demonstrated scenario
- SMART on FHIR app launch for DTR (demonstrated in a public test environment)
- ClaimResponse and FHIR Provenance (source X12 transaction identifiers) in converted output
X12 and RMap conversion
- X12 278 to FHIR PAS bundles
- FHIR PAS to X12 278: under development (see below)
- RMap to FHIR (simplified internal format option)
- FHIR Provenance (source X12 transaction identifiers)
Deployment planning
- On-premises or private cloud, assessed per customer
- Single-pass conversion architecture
- Docker for the conversion services; Kubernetes requirements assessed per customer; Helm charts not currently provided
- Database options assessed per deployment
Scope note: the Provider Directory API is required for certain payer types under CMS interoperability rules; it is not included in this suite at this time.
X12 278 and FHIR
Inbound: X12 278 to FHIR
Convert existing X12 278 prior authorization requests and responses to Da Vinci PAS FHIR. The output includes Provenance records with the source X12 transaction identifiers for the converted bundle. Published samples run in the public converter.
Outbound: FHIR to X12 278 (under development)
FHIR to X12 278 remains under development; supported inputs and validation results are confirmed during evaluation. Provider-generated PAS FHIR fixtures can be reviewed then.
Testing your own files requires an evaluation key and a supported input. Why latency matters: in a real-time prior authorization workflow, the conversion layer should add as little delay as possible. The native C core has no JVM overhead; conversion time is not the whole authorization decision time, so measure performance for your inputs and environment during evaluation.
A conversion layer behind your API
For payers, vendors, and integration teams building CMS-0057-F prior authorization, Redix can run as the X12 278 to Da Vinci PAS conversion layer behind your API architecture, preserving existing X12 and UM infrastructure. The conversion runs as a REST API, hosted in the Redix sandbox for evaluation or deployed behind your own gateway, on your servers or in Docker.
Scope: Redix is the conversion engine behind the workflow, not the payer's public CMS-0057-F API gateway, OAuth2/SMART authorization layer, or utilization-management decision engine. Redix converts; your platform orchestrates.
Fidelity, validation, and QA
Conversion Fidelity Report
For evaluation and implementation, a per-conversion report of the X12 segments recognized and the checks the conversion reported. Field-level mapping, the agreed profiles and terminology, and the receiving system's requirements are verified separately during evaluation.
Validation and QA
Tested synthetic 278 request output (June 2026 run) passed validation against the Da Vinci PAS profiles for CMS-listed PAS 2.0.1 and 2.1.0, with 2.2.1 as an additional validation target. A passing sample is not certification. A Redix FHIR audit step complements standard FHIR validators, catching structural issues schema validation alone can miss.
Choose the path that fits your infrastructure
A: FHIR-first
Build PAS workflows on FHIR, using RMap as a simplified internal format to generate PAS bundles without a full X12 278 stack.
B: Hybrid bridge
Keep X12 278 workflows running and add FHIR outputs for the partners who need them, migrating gradually.
C: Customer-specific
A customer-specific implementation using Redix conversion and the demonstrated API workflows as a starting point. Production scope, security, and integrations are agreed separately.
CMS-0057-F milestones
See the workflow on sample data
The public demo key accepts registered Redix samples only; do not upload production PHI. Public X12 278 / FHIR converter · Swagger API explorer · All demo tools · Live Sandbox
How the suite is licensed
AnyToAny Engine
Required. The core engine: single-pass processing, IFD/OFD definitions, and the runtime.
CMS-0057-F Suite
This package. X12 278 to Da Vinci PAS conversion, an RMap to FHIR option, and adjacent API support, with CRD, DTR, and PAS workflow demonstrations. Integration is scoped per customer; licensing the suite does not by itself make a payer compliant.
HIPAA X12 to FHIR
Optional add-on. X12 to FHIR R4 for 837, 835, 834, 270/271, and 276/277.
Plan your PAS architecture with us
Bring your current 278 flow and your FHIR plans. We map where Redix fits and what stays yours.