AWS HealthLake supports CMS Interoperability & Prior Authorization Rule
AWS HealthLake now offers native support for healthcare payers to meet the requirements of the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This update introduces four standardized FHIR-based APIs to facilitate patient and provider access to data, enable payer-to-payer data exchange, and streamline prior authorization processes. The new capabilities are designed to help organizations comply with mandates for standardized data access and reporting, with an effective date of January 1, 2027.
- →Patient Access API enhancements
- →Provider Access API improvements
- →Payer-to-Payer API functionalities
- →Prior Authorization API additions
- →API use metrics and compliance context
Features (4) ›
- Patient Access API enhancements
New capabilities include the CARIN IG for Blue Button 2.1.0 and SMART App Launch 2.0.0, enabling patients to access claims, encounter, and prior authorization data through third-party apps. The DaVinci PDex Drug Formulary 2.1.0 is also supported for patient queries on drug coverage.
- Provider Access API improvements
The Provider Access API now supports CARIN IG for Blue Button 2.1.0 for sharing patient data with in-network providers, and DaVinci PDex 2.1.0 for payer-to-provider clinical data exchange. It also includes drug formulary information for providers and integrates consent management.
- Payer-to-Payer API functionalities
This includes CARIN IG for Blue Button 2.1.0 and DaVinci PDex 2.1.0 for claims and clinical data exchange between payers. New operations like '$bulk-member-match' and DaVinci Data Export support bulk data transfer and member identification for efficient data exchange.
- Prior Authorization API additions
The Prior Authorization API integrates DaVinci Coverage Requirements Discovery (CRD) 2.1.0 and DaVinci Documentation Templates and Rules (DTR) 2.1.0 to check prior authorization needs and required documentation. DaVinci Prior Authorization Support (PAS) 2.1.0 enables end-to-end electronic prior authorization workflows.
Notes (1) ›
- API use metrics and compliance context
The release includes support for API use metrics collection for patient access, which aids in annual reporting requirements. AWS HealthLake is a HIPAA-eligible service, and customers are advised to consult legal and compliance counsel for their specific CMS-0057-F obligations.
https://aws.amazon.com/about-aws/whats-new/2026/05/aws-healthlake-cms-cms-0057-f/
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