We build and stabilize HL7 FHIR R4 APIs — Patient Access, Provider Access, Payer-to-Payer, and Prior Authorization — for payers and the system integrators who serve them.
The mandates are published. The deadlines are fixed. We help you ship compliant APIs.
CMS requires impacted payers — Medicare Advantage organizations, Medicaid and CHIP programs, and Qualified Health Plan issuers — to expose standards-based HL7 FHIR APIs.
Two final rules define the obligation. The Interoperability and Patient Access rule (CMS-9115-F) established the Patient Access API requirement. The Interoperability and Prior Authorization rule (CMS-0057-F) extends it with Provider Access, Payer-to-Payer, and Prior Authorization APIs, with compliance dates beginning January 1, 2027.
FHIR R4 API giving members access to claims, encounter data, and clinical data — extended under CMS-0057-F to include prior authorization decisions.
In-network providers retrieve member claims, clinical data, and prior authorization information through a FHIR API with attribution and opt-out handling.
When a member changes plans, their data follows them. Payers must exchange member data with other payers over FHIR, including bulk exchange at scale.
A public-facing FHIR API exposing provider directory data — names, network status, addresses, specialties — typically built on the Da Vinci Plan-Net implementation guide.
Providers query coverage requirements, submit prior authorization requests, and receive decisions — with status and reasons — through FHIR APIs built on the Da Vinci CRD, DTR, and PAS implementation guides.
A compliant FHIR API is mostly not FHIR. It is the pipeline behind it: mapping claims, eligibility, and clinical data out of core administration systems into conformant resources — correctly, repeatably, and at scale.
FHIR compliance projects fail in the data layer, not the API layer. Standing up a HAPI FHIR server is the easy part — populating it correctly from claims, enrollment, and prior authorization systems is where deadlines slip. That data engineering is exactly what we do.
We support payers directly or subcontract under prime system integrators delivering compliance programs. Whether you need a full implementation, remediation of a struggling one, or senior capacity added to an existing team, we integrate quickly and focus on shipping conformant APIs before the deadline.
The compliance dates are set,
and the implementation guides are published.
Let's talk about your FHIR roadmap.