CMS-0057 & Policy
Prior Authorization 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
CMS recommends the Da Vinci CRD, DTR, and PAS implementation guides as the way to build it, without mandating them. Drugs are excluded. The API complements rather than replaces the X12 278 mandate — enforcement discretion covers end-to-end FHIR use, but the 278 obligation formally remains.