January is coming. Prepare together.
The move to electronic prior authorization is a chance to remove repeated work from healthcare. It is also a risk: replace faxes with APIs, but leave providers connecting and testing plan by plan.
Meeting a requirement is not the same as making a market work.
Why January matters
CMS-0057-F requires affected payers to implement new and enhanced data-exchange APIs, with compliance dates generally beginning January 1, 2027. Exact dates vary by payer type. Some operational requirements began in 2026, and the rule’s prior-authorization provisions exclude drugs.
Health-plan commitments and state reforms add to the momentum. The practical question is how organizations connect their work, not simply whether each has an API.
Turn your implementation into a shared connection
Keep the APIs, utilization-management systems, policies and workflows you are already building. Use common connection and testing work to make those capabilities easier for providers and partners to reach.
Start with a test already on your plan. Where common evidence answers the same question for multiple connections, agree how to reuse it.
Bring the teams together before the deadline
Choose a technical lead, a provider or workflow partner, and one synthetic prior-authorization scenario. Test the full request and response, including missing information and status updates. Identify the remaining integration and support work while there is time to address it.
Follow the Road to January
The monthly Cut Paperwork, Not Care | Action Forum and hands-on testing events are opportunities to compare progress, resolve obstacles and reuse working approaches. The Delaware implementation page carries the planned schedule and participation contact.
Synthetic testing is open now. Limited production for ready medical prior-authorization workflows begins December 1. January 1 remains the medical-PA production focus.
Testing is open now; you do not need to wait for the next event or a production agreement.
No SHN compliance subscription
Supported prior-authorization exchange has no SHN network or transaction fee. Required connection software and status are part of the included service. Optional operating and software services have separate terms; details are on What’s Included.
Plans remain responsible for the requirements applying to their products. SHN participation and testing are not CMS certification or a substitute for that responsibility. Consult the CMS materials for the rule’s exact scope and dates.