Medicare Advantage, Medicaid, CHIP and federal-exchange QHP payers need Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs by January 1, 2027. We build them on AWS with HealthLake or a FHIR server, map your claims and clinical data to the required profiles, and wire prior authorization to your UM system.
8–16 weeks
$40k–$150k
CMS-0057-F requires impacted payers to have four FHIR APIs live by January 1, 2027, on top of the prior authorization timeframes and public metrics already in force in 2026. Most of the work is not the API: it is mapping years of claims and clinical data into the required profiles, matching members, and connecting prior authorization to the systems that make decisions. We do that work on AWS.
Current data sources, existing Patient Access API, vendor platforms and UM systems
A plan ordered by dependency: data and member matching first, then APIs in parallel
FHIR store and API layer on HealthLake or HAPI FHIR on ECS with Aurora PostgreSQL
Mapping pipelines with validation against the profiles
Authorization: SMART on FHIR for members, organization credentials and attribution for providers, consent for payer-to-payer exchange
Prior authorization services and integration with UM
Monitoring, throttling for bulk requests, audit logging, and metrics reporting
The four APIs in your AWS accounts, defined in code, with test evidence against the implementation guides and a runbook
Tell us about your current environment and goals. We'll review the details and respond with a proposed engagement structure and timeline.
Typical response time: 1–2 business days.
Prices and timelines are estimates for typical engagements, not offers. Scope, price and terms are set in a written agreement after we understand your situation. Terms of use.