CMS-0057-F Prior Authorization Suite.

Four CMS-mandated FHIR APIs. Da Vinci PAS v2.1.0 compliant. X12 278 to FHIR bidirectional conversion with RMap alternative. On-premises deployment.

Compliance deadline: January 1, 2027. API requirements for impacted payers begin January 2027. Some operational provisions begin in 2026 (varies by payer type).

See the workflow in action: Try the Da Vinci PAS demo with sample data (no PHI).

Patient Access API Provider Access API Payer-to-Payer API Prior Auth API Da Vinci PAS v2.1.0 X12 278 FHIR R4

CMS-PAS Docs: Product Overview Architecture Test Workflow Compatibility Matrix API Reference

Performance Specifications

Designed for mission-critical healthcare infrastructure. Native C engine with single-pass architecture.

<150ms

Typical end-to-end processing latency

99.999%

Production uptime across deployments

Single-Pass

Validate and transform together

Native C

No JVM overhead or GC pauses

Who It's For

One suite for payers, providers, clearinghouses, and platform vendors under CMS-0057-F.

Health Plans

Medicaid, Medicare Advantage, and commercial payers under CMS-0057-F mandate.

Providers & Health Systems

Organizations integrating PA workflows into EHR/RCM and provider access APIs.

TPAs & Clearinghouses

Organizations processing prior authorization on behalf of health plans.

Platform Vendors

EHR, RCM, and integration vendors adding CMS compliance to their stack.

What's In The Suite

Core components for CMS-0057-F compliance in one suite.

CMS-Mandated APIs

Patient Access API
Provider Access API
Payer-to-Payer API
Prior Authorization API (PAS workflows + status/decision access)

Da Vinci IG Support

Da Vinci PAS v2.1.0 ($submit, $inquire, $cancel, $update)
CRD-aligned support (coverage requirements discovery)
DTR-aligned support (templates/rules integration)
ClaimResponse + Provenance tracking

X12 & RMap Conversion

X12 278 ↔ FHIR PAS bundles (bidirectional)
RMap ↔ FHIR (simplified internal format option)
Full Provenance audit trail

Enterprise Ready

On-premises / private cloud deployment
Low-latency, high-throughput (single-pass architecture)
Docker & Kubernetes support
SQL Server, Oracle, PostgreSQL options

Scope note: 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 to FHIR Conversion

Bidirectional conversion between X12 278 and FHIR R4 Da Vinci PAS bundles. Native C engine with sub-150ms latency.

Inbound: X12 278 to FHIR

Convert existing X12 278 prior authorization requests and responses to FHIR format, including Provenance resources for audit trail compliance.

curl -X POST "https://demo.redix.com/api/v2/hipaa-to-fhir/278-request" \
  -H "X-API-Key: demo-key-12345" \
  -F "file=@prior_auth_request.x12"

Outbound: FHIR to X12 278

When your API receives a FHIR PAS bundle from a provider, convert it to X12 278 for your legacy backend systems.

curl -X POST "https://demo.redix.com/api/v2/fhir-to-hipaa/278-request" \
  -H "X-API-Key: demo-key-12345" \
  -H "Content-Type: application/fhir+json" \
  -d @fhir_claim_bundle.json

Why sub-150ms matters: In a real-time Prior Auth workflow, the conversion layer must add negligible latency. A provider's EHR sends the request, the payer API processes it, and the decision returns — all while the patient is still in the exam room. Redix's native C engine uses a single-pass architecture with no JVM overhead and no garbage collection pauses.

Solution Type	Typical Latency	Real-Time Capable?
Java-based converters	2-5 seconds	No — timeout risk
Python-based converters	1-3 seconds	Marginal
Redix (Native C)	< 150ms	Yes

Working Code Examples

Python examples for the three core conversion operations.

Convert X12 278 Request to FHIR (with Provenance)

from redix_client import RedixClient

client = RedixClient(
    base_url="https://demo.redix.com",
    api_key="demo-key-12345"
)

# Convert X12 278 Request to FHIR
result = client.post("/api/v2/hipaa-to-fhir/278-request",
    files={"file": "/path/to/278_request.x12"}
)

# Result contains FHIR Claim bundle with Provenance
fhir_bundle = result["fhir_bundle"]
print(f"Resource Type: {fhir_bundle['resourceType']}")
print(f"Entries: {len(fhir_bundle.get('entry', []))}")

# Extract Provenance for audit trail (CMS-0057-F requirement)
for entry in fhir_bundle.get("entry", []):
    resource = entry.get("resource", {})
    if resource.get("resourceType") == "Provenance":
        print(f"Recorded: {resource.get('recorded')}")
        print(f"Activity: {resource.get('activity', {}).get('coding', [{}])[0].get('display')}")

Convert X12 278 Response to FHIR ClaimResponse

# Convert X12 278 Response to FHIR ClaimResponse
result = client.post("/api/v2/hipaa-to-fhir/278-response",
    files={"file": "/path/to/278_response.x12"}
)

fhir_response = result["fhir_bundle"]
for entry in fhir_response.get("entry", []):
    resource = entry.get("resource", {})
    if resource.get("resourceType") == "ClaimResponse":
        print(f"Status: {resource.get('status')}")
        print(f"Outcome: {resource.get('outcome')}")
        # CMS-0057-F requires specific denial reasons
        if resource.get('outcome') == 'error':
            for error in resource.get('error', []):
                print(f"Denial Reason: {error.get('code', {}).get('text')}")

Convert FHIR PAS Bundle to X12 278 (Reverse Direction)

import json

# Load FHIR PAS bundle from provider
with open("fhir_claim_bundle.json", "r") as f:
    fhir_bundle = json.load(f)

# Full pipeline: FHIR to X12 278 in one call
x12_result = client.post("/api/v2/fhir-to-hipaa/278-request",
    json=fhir_bundle,
    headers={"Content-Type": "application/fhir+json"}
)

# Submit X12 278 to legacy authorization system
x12_content = x12_result.get("x12_content")

Try it live: All API endpoints are available in the Swagger API explorer. Use the demo API key demo-key-12345 with sample X12 278 files.

Choose the path that fits your existing infrastructure. Keep running X12, start fresh with FHIR, or deploy the full suite.

How You Can Adopt

Option A: FHIR-First Path

Build PAS workflows on FHIR. Use RMap as a simplified internal format to generate PAS bundles without standing up a full X12 278 stack.

RMap → FHIR conversion
Simplified internal format
Faster path for new implementations

Option B: Hybrid Bridge

Keep X12 278 workflows running. Add FHIR outputs for trading partners who need them.

X12 278 ↔ FHIR bridge
Preserve existing EDI
Gradual migration

Option C: Full Suite

APIs + conversion + audit/provenance. Complete CMS-0057-F compliance with full traceability.

All 4 CMS APIs
X12 + RMap conversion
Provenance audit trail

CMS-0057-F Timeline

Key compliance milestones based on the CMS-0057-F final rule schedule.

Jan 1, 2026

Operational requirements start
(varies by payer type)

→

Mar 31, 2026

Initial public reporting
milestones

→

Jan 1, 2027

API requirements start
(varies by payer type)

Want to see the workflow in action? Try the Da Vinci PAS demo with sample data (no PHI). Or explore the full Live Sandbox.

Live Sandbox Tools

PAS Prior Authorization Demo

CMS-0057-F workflow with sample data

X12 to FHIR

HIPAA EDI to FHIR R4 bundles

FHIR to RMap

FHIR R4 to tabular format

X12 to RMap

HIPAA to tabular intermediate

PAS Prior Authorization Demo

Preview the ePA workflow with sample data — CRD, DTR, PAS submit, approval

All ten tools are available here. Interactive ePA workflow demo here. Swagger API explorer here.

CMS-0057-F Documentation

Platform Overview

What CMS requires and how Redix covers it.

Architecture

Technical architecture for your engineering team.

Test Workflow

Step-by-step integration and testing guide.

Compatibility Matrix

Detailed compliance mapping against CMS requirements.

API Reference

Endpoints, authentication, and code samples.

Licensing

AnyToAny Engine

Required. Core conversion engine providing the single-pass architecture, IFD/OFD processing, and runtime environment.

CMS-0057-F Suite

This package. Four CMS-mandated APIs, Da Vinci PAS v2.1.0, X12 278 to FHIR conversion, and RMap to FHIR option.

HIPAA Package

Optional add-on. Full HIPAA X12 to FHIR conversion for 837, 835, 270/271, 276/277, 834, 820 transactions.

Modular pricing. The AnyToAny Engine is the core product required for all conversions. Each module is licensed separately based on your requirements. Request an evaluation to discuss your implementation.