X12 278 to Da Vinci PAS FHIR Conversion

Achieve FHIR prior authorization compliance without abandoning your legacy X12 and UM infrastructure.

Sample data only, do not paste PHI.

To test your own de-identified X12 278 files, request an evaluation key.

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.

  • Forward X12 278 to Da Vinci PAS FHIR (request and response): available in the sandbox and with an evaluation key. Reverse FHIR PAS to X12 278: available through a private guided technical review using your synthetic fixtures.
  • Validated against the Da Vinci PAS profiles: output checked with the HL7 FHIR Validator, targeting CMS-listed PAS 2.0.1 and 2.1.0
  • CMS-0057-F aligned: supports the Prior Authorization API workflow
  • Deploy on-premises, all data stays in your environment
  • Available as a REST API: the same X12 278 to FHIR PAS conversion can run as a REST API conversion layer behind your API architecture. Forward conversion is available in the Redix sandbox and with an evaluation key; reverse FHIR to X12 access is scoped for private technical review or deployment evaluation.

Dual-Stack: X12 278 + FHIR PAS

Redix supports dual-stack X12 278 and FHIR PAS workflows, so you do not need to abandon your existing X12 infrastructure as you work toward CMS-0057-F. Forward X12 278 to FHIR PAS conversion is available in the sandbox and with an evaluation key; reverse FHIR PAS to X12 278 is handled through private technical review using your synthetic fixtures.

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 the Conversion Fidelity Report: See which X12 segments were recognized and whether the output validates cleanly against the Da Vinci PAS profiles (HL7 FHIR Validator, CMS-listed PAS 2.0.1/2.1.0), a segment inventory and validation summary
  4. View the response/decision: See the ClaimResponse with review status, reasons, and authorization details

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 supports dual-stack X12 278 and FHIR PAS workflows: forward X12 278 to FHIR PAS conversion is available in the sandbox and with an evaluation key, and reverse FHIR PAS to X12 278 is handled through private technical review using synthetic fixtures.
Can Redix support dual-stack X12 278 and FHIR PAS during the transition?
Yes. Redix supports dual-stack X12 278 and FHIR PAS workflows, so you do not need to abandon your existing X12 infrastructure as you work toward CMS-0057-F. Forward X12 278 to FHIR PAS conversion is available in the sandbox and with an evaluation key; reverse FHIR PAS to X12 278 is handled through private technical review using synthetic fixtures.
How does the demo handle attachments and additional documentation?
This PAS 278 demo focuses on request and response conversion. Attachments and additional clinical documentation should be scoped separately based on the payer workflow, DTR/CDex requirements, X12 attachment requirements, and FHIR DocumentReference requirements.
Can this be deployed on-premises with no PHI leaving our environment?
Yes. Redix conversion components can be deployed on-premises so production PHI remains inside your environment. The public online demo is for sample or de-identified data only and should not be used with PHI.
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 Redix conversion components in your own environment (Docker or on-premises). 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.

Used in production by large healthcare organizations, including Fortune 500 companies. Trusted for over a decade in healthcare data integration.

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