CMS-0057 & Policy
Payer-to-Payer API
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Its prior-auth payload is the operationally interesting part: incoming members arrive with their authorization history, supporting continuity-of-care policies that honor existing approvals during transitions. Churn-heavy markets (Medicaid, Marketplace) see the most traffic.