Availity, Onyx Launch Turnkey Solution to Meet Prior Authorization, Interoperability Rule

Availity, the nation’s largest real-time health information network, and Onyx, a leader in Fast Healthcare Interoperability Resources (FHIR)–based interoperability, have joined forces to launch a comprehensive solution designed to help health plans meet the CMS-0057 Interoperability and Prior Authorization Final Rule.¹ With compliance deadlines fast approaching, the new platform aims to simplify regulatory adherence, reduce administrative burden, and future-proof payer infrastructure for long-term success.

A new partnership delivers a scalable Fast Healthcare Interoperability Resources (FHIR) solution to help payers meet CMS' Interoperability and Prior Authorization Final Rule by 2027. | Image Credit: elenabsl - stock.adobe.com

“CMS-0057 is a pivotal moment for the health care industry,” Mark Scrimshire, chief interoperability and security officer at Onyx, said in a statement.¹ “Our partnership with Availity brings together best-in-breed capabilities across our respective platforms to enable health plans to meet these mandates with confidence—while also unlocking long-term value through automation, interoperability, and improved provider collaboration.”

Issued on January 17, 2024, CMS-0057-F aims to improve health information exchange and streamline prior authorization processes.² Building on earlier interoperability efforts, the rule requires impacted payers to adopt standardized application programming interfaces (APIs) to enhance data sharing among patients, providers, and payers, ultimately reducing administrative burden and keeping patients at the center of care. While some provisions must be implemented by January 1, 2026, the majority of API requirements are due by January 1, 2027.

"You can invest in leveraging responsible AI, really transforming the experience with a focus towards automation," Sean Barrett, chief product officer at Availity, told The American Journal of Managed Care® (AJMC®). "That would allow us to rapidly reduce the provider abrasion [and] ultimately have cost savings on both sides of the provider-payer interaction."

However, a WEDI survey raised significant concerns about the health care industry’s readiness to meet the CMS-0057-F Final Rule requirements, with many payers and providers either yet to begin or only partially through implementing mandated APIs.³ The findings point to widespread challenges, including insufficient funding, unclear interoperability strategies, and complex workflow adjustments, that are slowing progress toward compliance. With the January 2027 deadline drawing closer, the slow adoption pace underscores the urgent need for coordinated action and support to meet the rule’s ambitious goals for data sharing and prior authorization reform.

The Availity-Onyx solution aims to provide a platform to support health plans in meeting the CMS-0057-F Final Rule requirements.¹ Key capabilities include a secure, cloud-agnostic FHIR server with a data transformation layer that standardizes information for compliance. The platform offers patient access and provider directory APIs that allow members to access claims, encounters, and clinical data, along with a developer portal and app store for third-party integrations. It also includes prior authorization APIs to support connectivity with utilization management vendors, providers, and health plans. Furthermore, payer-to-payer and provider access APIs, along with connectivity hubs, enable secure data sharing and help facilitate compliance with data exchange mandates.

Moreover, this solution aims to bring long-term value by providing a unified, scalable platform that supports not only regulatory compliance but also ongoing operational efficiency and adaptability. Its national network infrastructure eliminates the need for point-to-point integrations, making it easier for stakeholders to adopt and connect. Additionally, features such as SMART-on-FHIR authentication, API-first design, and real-time reporting dashboards further support integration, oversight, and improvement.

"If we can increase transparency in the ecosystem and at least have the conversation be about the same facts or the same source, system, or source of truth, then that can elevate the conversation and take a lot of the friction out of the ecosystem, which is what I wake up every day trying to solve," said Barrett.

References

1. Availity and Onyx launch comprehensive CMS-0057 compliance platform for health plans powered by the Availity Network. News release. Availity. August 6, 2025. Accessed August 7, 2025. https://www.businesswire.com/news/home/20250806279473/en/Availity-and-Onyx-Launch-Comprehensive-CMS-0057-Compliance-Platform-for-Health-Plans-Powered-by-the-Availity-Network

2. CMS interoperability and prior authorization final rule (CMS-0057-F). News release. CMS. Last updated July 29, 2025. Accessed August 7, 2025. https://www.cms.gov/priorities/burden-reduction/overview/interoperability/policies-and-regulations/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f

3. Santoro C. Survey finds slow start on CMS interoperability rule implementation. AJMC^®. April 10, 2025. Accessed August 7, 2025. https://www.ajmc.com/view/survey-finds-slow-start-on-cms-interoperability-rule-implementation