administrative standard
CMS APIs: CMS Interoperability and Prior Authorization API Readiness
Prepare payer, provider, and prior-authorization workflows for API-based evidence packets while retaining payer/trading-partner approval and no-guarantee reimbursement boundaries.
Versions and profiles
Deployment scope must be selected and verified before live exchange.
01Patient Access API
02Provider Access API
03Payer-to-Payer API
04Prior Authorization API
05deployment-specific payer policy
Approved exchange scope
- coverage and prior-authorization context
- payer evidence packets
- missing-documentation review
- status and decision metadata
Required conformance artifacts
- payer API scope
- synthetic prior-auth fixture
- human RCM review
- policy-source attribution
- audit trail
Required before live use
- payer-specific validation
- no autonomous submission
- no reimbursement guarantee
- coding review
- legal and customer approval
Contract bindings
Connector contracts using this standard.
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planning boundary
This standard remains visible for future scoped contract work.Primary sources