“Quick-Start Guide: Get Audit-Ready for CMS-0057 Enforcement”
This playbook explores why, for payers, it’s time to move beyond implementation and focus on a critical last-mile step: CMS-0057 audit readiness.
The final enforcement of rules around healthcare data exchange and prior authorizations is coming soon. The CMS Interoperability and Prior Authorization Final Rule (CMS-0057) begins on January 1, 2027 — meaning it’s time for API execution. But developing the required APIs isn’t enough to meet the requirements. CMS expects additional behind-the-scenes validation and payers that treat their API audit infrastructure as a strategic asset will be ready.
This playbook explores why, for payers, it’s time to move beyond implementation and focus on a critical last-mile step: audit readiness. Organizations that lean into a proactive rather than reactive strategy will likely be the most audit-ready come January 2027. Highlights include:
- What CMS requires from APIs and how audits will scrutinize them to ensure compliance.
- How to create complete, defensible — and future-proofed — API audit logs.
- Five practical steps to take before 2027 to lower audit risk on the way to CMS-0057 readiness.