What is the CMS-0057-F PARDD API?

CMS-0057-F is the CMS Interoperability and Prior Authorization final rule. It requires impacted payers to operate four FHIR APIs: Patient Access, Provider Access, Payer-to-Payer, and a Prior Authorization API (PARDD). The prior-auth and operational provisions phase in through 2026, and the APIs are required by January 1, 2027.

How fast do payers have to decide under the rule?

Impacted payers must send prior authorization decisions within 72 hours for expedited (urgent) requests and 7 calendar days for standard requests, and must include a specific reason for any denial. The Prior-Auth Agent tracks those clocks and captures the denial reason in a structured, appealable form.

How do Da Vinci PAS, CRD and DTR fit together?

CRD (Coverage Requirements Discovery) answers whether prior auth is required; DTR (Documentation Templates & Rules) gathers the required documentation from the record; PAS (Prior Authorization Support) submits the request and returns the decision. Together they are the FHIR implementation of the PARDD loop.

Do we have to replace our X12 278 infrastructure?

No. The agent bridges X12 278 ↔ FHIR bidirectionally, so your existing EDI clearinghouse and payer connections keep working while FHIR clients get the modern PARDD experience. You modernize incrementally, not in a rip-and-replace.

How ready is the industry for the 2027 deadline?

Not very. As of WEDI's October 2025 survey, roughly 43% of payers and 47% of providers had not yet started their CMS-0057-F work. The deadline is January 1, 2027, so we treat it as a countdown that's already running.

Prior-Auth Agent

CMS-0057-F is a deadline, not a project

Prior authorization is the most hated workflow in healthcare. By January 1, 2027, impacted payers must run it over a FHIR PARDD API. The Prior-Auth Agent automates the whole loop: check requirements, gather documentation, submit, and handle the decision, bridging X12 278 ↔ FHIR so nothing in your stack breaks.

CMS-0057-F PARDD API + Da Vinci PAS / CRD / DTR
X12 278 ↔ FHIR R4, bidirectional
Auto-assembled documentation, tracked decision clocks

For payers

The PARDD loop

1
CRD
Is prior auth required?
2
DTR
Gather the documentation
3
PAS
Submit over PARDD
4
Decision
Approve · pend · deny + reason

Decision clock: 72 hrs expedited · 7 days standard

In short

The Prior-Auth Agent runs end-to-end electronic prior authorization on the CMS-0057-F Prior Authorization (PARDD) API using Da Vinci PAS / CRD / DTR. It discovers whether prior auth is required, assembles the documentation automatically, submits the request while bridging X12 278 ↔ FHIR, and handles the decision — tracking the CMS timeframes (72 hours expedited, 7 calendar days standard) and parsing denial reasons into appealable form. Required for impacted payers by January 1, 2027.

Jan 1 2027

PARDD API required

operational provisions in 2026

72 hrs

Expedited decision

7 days standard

278 ↔ FHIR

Bidirectional bridge

keep your EDI stack

~43%

Payers not started

WEDI, Oct 2025

The PARDD loop

Four steps, fully automated

The Da Vinci prior-authorization loop (CRD → DTR → PAS → decision) runs end to end by the agent, with a human confirming only what the payer rules genuinely require.

1
1 · Is PA required? (CRD)
At the point of order, Da Vinci Coverage Requirements Discovery queries the payer and returns whether prior authorization is required (and the rules behind the answer) before the clinician moves on.
2
2 · Gather documentation (DTR)
Documentation Templates & Rules pulls the payer's questionnaire, auto-answers it from the EHR/FHIR record (CQL), and flags only the gaps a human must fill — no re-keying.
3
3 · Submit (PAS)
The Prior Authorization Support transaction submits the request over the PARDD API, bridging X12 278 ↔ FHIR so both the payer's EDI stack and modern FHIR clients stay in sync.
4
4 · Decision & follow-up
Approvals, pended status and denials return with structured reasons. The agent tracks the CMS decision clock, parses denial reasons, and drafts the appeal or resubmission automatically.

Capabilities

What the Prior-Auth Agent handles

Everything from coverage discovery to appeal drafting — on standards, with a full audit trail.

CMS-0057-F PARDD API

Native support for the Prior Authorization API (PARDD) that impacted payers must operate under the CMS Interoperability and Prior Authorization final rule.

Da Vinci PAS / CRD / DTR

The full FHIR prior-auth stack (Coverage Requirements Discovery, Documentation Templates & Rules, and Prior Authorization Support) wired together end to end.

X12 278 ↔ FHIR bridging

Translate bidirectionally between the legacy X12 278 request/response and FHIR R4, so payers can modernize without abandoning their EDI backbone.

Automated documentation assembly

Auto-answer DTR questionnaires from the clinical record with CQL, attach supporting documents, and surface only the fields a human actually needs to complete.

Decision-clock tracking

Monitor the CMS-mandated timeframes (72 hours for expedited requests, 7 calendar days for standard) and alert before a payer misses them.

Denial handling & appeals

Parse structured denial reasons, explain them in plain English, and draft the appeal or corrected resubmission automatically.

The 2027 clock is already running

CMS-0057-F requires four FHIR APIs, Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization (PARDD), with operational provisions in 2026 and the APIs due January 1, 2027. Yet roughly 43% of payers and 47% of providers had not started as of October 2025. Read the full breakdown of what the rule requires and how to sequence it.

CMS-0057-F explained See it in the fleet

Security & Compliance

Where our compliance actually stands

Protecting PHI is non-negotiable. Here's exactly where our certifications stand — no overclaiming.

HIPAAActive

Compliant · BAAs available

SOC 2 Type IIIn Progress

Audit in progress

HITRUST CSFOn Roadmap

On roadmap

HL7 · FHIRCore

Native, by design

AWS HIPAA-eligible infrastructure · Business Associate Agreements (BAAs) · Encryption in transit & at rest · See our security details →

Frequently asked questions

Ready for the CMS-0057-F prior-auth deadline?

See the PARDD loop run on a real prior-authorization scenario, with X12 278 ↔ FHIR bridging on your own transactions.

Solutions for payers