Reimagining Prior Authorization: A Blueprint for CMS-0057-F Compliance & Beyond

Ashwin Athri, MBA | EVP, Strategy, Innovation & Partnerships 
Lance Grady | EVP, Managing Partner

The prior authorization (PA) process has long presented challenges in terms of administrative burden, variability, and delays in care. With the release of CMS-0057-F, the regulatory landscape is shifting in a way that requires stakeholders across healthcare to reassess and redesign how PA is managed—especially from a technology and infrastructure perspective. 

We've developed a technical report that explores the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule in depth. The document offers a scalable architectural blueprint to support compliance, streamline workflows, and enable enterprise-level automation built on Fast Healthcare and Interoperability Resources (FHIR) standards. 

What the Report Covers

This isn’t just a compliance checklist. The report breaks down:

• The regulatory imperative behind CMS-0057-F, including aggressive new timeframes, transparency requirements, and API mandates.
• Why the shift from X12 278 to FHIR is unavoidable, and how to manage the transition without creating operational chaos.
• The architecture needed for true end-to-end automation, including micro-services, AI/NLP modules, BPM orchestration, and robust data governance layers.
• The real-world Da Vinci workflow (CRD, DTR, PAS) and what it takes to make it work inside the EHR—not just on paper.
• Strategies for provider adoption, trust-building with AI, and how to measure success beyond check-the-box compliance.

Explore the Highlights

Want a quick overview first? We've built a visual summary of the architecture and workflow that breaks down the big ideas in an easy-to-scan format. Check out the visual report. 

Ready for the Deep Dive?

Download the full report for the full architectural blueprint, complete with diagrams, implementation strategies, and guidance on key technical components.

For more insights on how our consulting team is helping health plans operationalize this transition, explore our consulting capabilities here.

To speak to a member of our team directly, please contact Ashwin Athri or Lance Grady: ashwin.athri@precisionaq.com and lance.grady@precisionaq.com.