CMS-0057-F and CMS-0062-P deadlines are closing in, and no one inside your plan can prove — line by line — that your prior-authorization policy matches federal and state rules. Compliance maps your PA policy against them continuously and returns a precise gap report: what's compliant, what isn't, what to fix first.
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Two CMS mandates define what ‘compliant’ looks like for prior authorization. Compliance maps your internal PA policy against them, line by line — so you know exactly what to fix first.
FHIR-based PA APIs across 14 service categories. Applies to Medicaid, CHIP, Medicare Advantage, and federal-exchange QHPs — every plan in your book of business.
Extends electronic prior authorization to 20 drug classes under the medical benefit — immunomodulators, oncology injectables, specialty infusions, biosimilars.
Operational provisions of CMS-0057-F went live on January 1, 2026. The FHIR PA API mandate lands January 1, 2027 — and CMS-0062-P arrives nine months later. Here's where today sits on that runway.
Upload your PA policy. We return a CFR-cited gap report ordered by what fails an audit today, what fails next, and what's already compliant — so you know exactly what to fix first.
Standard PA turnaround — 14 days, should be 7
Deadline passed
Your policy allows 14 days. CMS-0057-F requires 7 calendar days for standard PA decisions since Jan 1, 2026.
42 CFR §438.210(d) · Texas · assigned to Policy team
2025 public PA metrics — not published
21 days overdue
Approval rate, denial rate, and average turnaround must be posted publicly. Required by March 31, 2026.
45 CFR §156.122(h) · all 4 states · unassigned
Denial reason specificity — generic language in notices
Operational
Notices cite "clinical criteria not met" without the specific criterion. CMS requires a specific, patient-facing reason per denial.
45 CFR §156.122(g)(3) · California Medi-Cal · assigned to UM Operations
FHIR-based PA API — not implemented
254 days left
Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs must be live by Jan 1, 2027.
CMS-0057-F · all 4 states · vendor selection in progress
Drug-benefit PA coverage — scope undefined
Proposed rule
Your policy doesn't yet address the 20 drug classes covered by CMS-0062-P (immunomodulators, oncology injectables, biosimilars).
CMS-0062-P (proposed) · all 4 states · under review
Expedited PA turnaround — 72 hours
Verified
Your policy meets the 72-hour requirement for urgent requests across all 4 states.
42 CFR §438.210(d)(2) · all 4 states · re-verified Apr 2026
CFR-cited · reviewed by Auth57 compliance team.
Open full report →CMS-0057-F and CMS-0062-P are not future requirements. Operational provisions went live January 1, 2026. If you haven't audited your PA policies against these requirements, you're already behind.
PASSED — Jan 1, 2026
Operational requirements live
7-day standard PA decisions. 72-hour expedited. Specific denial reasons required.
PASSED — Mar 31, 2026
First public metrics report due
Approval rates, denial rates, average turnaround times — posted publicly on your website.
UPCOMING — Jan 1, 2027
FHIR API compliance deadline
Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization APIs must be live.
WHERE YOU SHOULD BE NOW
Gap analysis complete, remediation underway
Know what's compliant, what isn't, and have a plan to close the gaps before enforcement begins.
Every rule is monitored, verified, and updated by our team before it reaches you. We read the sources — CMS bulletins, state Medicaid agency notices, payer policy updates — so your team never has to call to confirm.
Rule update
LiveGLP-1 step therapy
Step therapy requirement updated. Prior treatment failure documentation now required. Effective April 1, 2026.
Reviewed by Auth57 team · Source: HHSC Medicaid bulletin
Pending review
VerifyingCA Medi-Cal · biosimilars PA exemption
Proposed exemption for FDA-approved biosimilars under review. Not yet in effect — team monitoring.
Auth57 team review in progress · Source: DHCS bulletin draft
Confirmed unchanged
VerifiedNJ FamilyCare · oncology oral PA requirements
Quarterly verification complete. No changes to PA requirements for oral oncology agents.
Verified April 2026 · Source: NJDOH policy manual
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Upload your policy documents and get a gap report in 48 hours. Know exactly where you stand before the deadline finds you.