Prior Authorization (PAS) Demo: See CMS-0057-F Data Flow with Sample Inputs

Understand the PAS data flow before you build: requests, decisions, and audit trail, using CMS-aligned patterns.

Sample data only, do not paste PHI.
Try PAS Demo (sample data) Request a CMS-0057-F Readiness Review

What This Tool Does

This is a Prior Authorization API (Da Vinci PAS) demo for CMS-0057-F, showing both FHIR PAS bundles and X12 278 equivalents. See how a prior authorization request is created, submitted, and decided, using either format.

  • Da Vinci PAS-aligned: $submit, $inquire, and $cancel operations
  • Bidirectional X12 278 and FHIR PAS: bridge legacy and FHIR during transition
  • CMS-0057-F aligned: supports the Prior Authorization API workflow
  • Deploy on-premises, all data stays in your environment

Dual-Stack: X12 278 + FHIR PAS

Redix provides bidirectional conversion between X12 278 and FHIR PAS bundles, enabling organizations to maintain existing X12 278 workflows while simultaneously supporting the FHIR prior authorization API requirements under CMS-0057-F. You do not need to abandon your current X12 infrastructure as you work toward CMS-0057-F.

What You'll See in the Demo

  1. Create a prior authorization request: Start with a sample PA request for a medical service requiring pre-approval
  2. Generate PAS payload: See the FHIR Claim bundle with PAS extensions, or the equivalent X12 278 request
  3. Review validation and traceability: Check the structural validation results and mapping audit trail
  4. View the response/decision: See the ClaimResponse (approved, modified, or pended) with review reasons and authorization numbers

For the full end-to-end ePA workflow including CRD (Coverage Requirements Discovery) and DTR (Documentation, Templates, and Rules), try the CMS-0057-F Compliance Demo.

CMS-0057-F Context

CMS-0057-F requires impacted payers to implement or enhance FHIR-based APIs on the CMS timeline, with major API requirements generally beginning January 1, 2027. This demo focuses on the Prior Authorization API (Da Vinci PAS), one of the most technically complex of these requirements. Redix provides on-premises components that can support CMS-0057-F API modernization, including prior authorization workflows, while preserving existing X12 infrastructure. For the full regulatory overview, see the CMS-0057-F Executive Overview.

Frequently Asked Questions

What does CMS-0057-F require and what is the 2027 deadline?
CMS-0057-F requires impacted payers to implement or enhance FHIR-based APIs on the CMS timeline, with major API requirements generally beginning January 1, 2027. These include Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization API requirements.
What is Da Vinci PAS and how does it relate to X12 278?
Da Vinci PAS (Prior Authorization Support) is the HL7 FHIR Implementation Guide that defines how prior authorization requests and responses are exchanged via FHIR APIs. X12 278 is the existing HIPAA EDI standard for prior auth. During the transition period, many organizations need both, Redix provides bidirectional X12 278 and FHIR PAS conversion so you can accept and produce either format.
Can Redix support dual-stack X12 278 and FHIR PAS during the transition?
Yes. Redix provides bidirectional conversion between X12 278 and FHIR PAS bundles, enabling organizations to maintain existing X12 278 workflows while simultaneously supporting the FHIR prior authorization API requirements under CMS-0057-F. This dual-stack approach means you do not need to abandon your current X12 infrastructure as you work toward CMS-0057-F.
How does the demo handle attachments and additional documentation?
The PAS workflow supports additional documentation through the DTR (Documentation, Templates, and Rules) step, where required clinical information is collected before the $submit operation. In production, attachment and documentation mapping should be scoped based on the payer workflow, X12 attachment requirements, and FHIR DocumentReference requirements.
Can this be deployed on-premises with no PHI leaving our environment?
Yes. The Redix CMS-0057-F suite, including the X12 278 and FHIR PAS converter, API components, and the validation engine, deploys on-premises. All data processing happens within your environment. No PHI is transmitted to external services.
What is the fastest way to assess our CMS-0057-F readiness?
Schedule a 30-minute technical consultation. Redix can review your current X12 278 infrastructure, identify gaps relative to CMS-0057-F requirements, and discuss an appropriate evaluation path. You can also try the demo on this page to see the workflow in action with sample data.

Need this running in your environment?

Run the same Redix engine in your own environment (Docker or on-prem). No PHI leaves your system.

Request Technical Evaluation

We will help you choose the right evaluation path for sample testing, API testing, or deployment in your own environment.

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