Auth57 Compliance

The rules changed.
Did your policy?

Upload your PA policy documents. We map them against CMS-0057-F and CMS-0062-P requirements and verified state rules — rules that our team monitors, checks, and updates continuously. You get a precise gap report: what's compliant, what isn't, and what to fix first.

CMS-0057-F · Final Rule
Electronic PA mandate — 14 service categories. API deadline: Jan 1, 2027
CMS-0062-P · Proposed Rule
Extends PA to 20 drug classes under medical benefit. Proposed deadline: Oct 1, 2027
Human-verified rules Gap report in 48 hours Team monitors every source daily

Jan 1

2026 operational deadline

Jan 1

2027 API deadline

$15B

CMS projected 10-yr savings

10,402

Verified rules in database

What you receive

A gap report, not a checklist.

Upload your PA policy as PDF or CSV. We return a structured gap analysis showing exactly where you deviate from CMS-0057-F, CMS-0062-P, and current state requirements.

Gap report

Your plan vs CMS-0057-F + CMS-0062-P · 4 states

Generated 2026-04-06

3 critical gaps

Standard PA turnaround — Texas Medicaid MCO

Your policy states 14 days. CMS-0057-F requires 7 calendar days effective Jan 1, 2026.

CRITICAL — operational deadline passed

Public PA metrics reporting — All states

Your plan has not published 2025 PA metrics. Required by March 31, 2026.

CRITICAL — reporting deadline passed

Denial reason specificity — California Medicaid

Denial notices reference "clinical criteria not met" without specific criteria cited. CMS requires specific reason per denial.

WARNING — remediation needed

Prior Authorization API — All states

FHIR-based PA API not yet implemented. Deadline: January 1, 2027.

WARNING — 9 months remaining

Expedited PA turnaround — All states

Your policy states 72 hours for urgent requests. Meets CMS-0057-F requirement.

COMPLIANT

The deadline reality

The clock is already running.

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.

How we stay current

Human-verified.
Always current.

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.

CMS.gov regulatory updates and final rules

State Medicaid agency bulletins — all 51 states

Medicare Advantage and Part D plan communications

WISeR pilot program data and model updates

Federal Register notices and proposed rules

Rule update

● Live

TX Medicaid MCO — GLP-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

● Verifying

CA 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

● Verified

NJ FamilyCare — oncology oral PA requirements

Quarterly verification complete. No changes to PA requirements for oral oncology agents.

Verified April 2026 · Source: NJDOH policy manual

Pricing

Annual compliance monitoring.

⚠ Deadline: January 1, 2027 for API compliance

Don't find your gaps in a CMS audit.

Upload your policy documents and get a gap report in 48 hours. Know exactly where you stand before the deadline finds you.