Payers aren’t wondering if they should implement FHIR – most already have. The real challenge now is meeting the aggressive timelines of the CMS-0057-F Prior Authorization Final Rule. Firely helps payers move from partial implementation to full regulatory readiness – without ripping and replacing existing systems in one hit. 

Firely’s Prior Authorization solution checks the CMS-0057-F box: 

• Meets CMS-0057-F Requirements: Firely Server supports the FHIR APIs, standards (including US Core), and prior authorization workflows required for compliance. 

• Built-in Da Vinci IG Support: Native support for Da Vinci guides like PAS and CRD accelerates implementation and minimizes custom development. 

• Integrates with Existing Systems: Designed for seamless integration into current IT environments with no need to rebuild your data infrastructure from scratch. 

• Supports Real-Time Data Exchange: Deliver timely, electronic prior authorization responses to meet both provider expectations and regulatory mandates. 

The Challenge for Payers

As the healthcare industry shifts toward interoperability and real-time data exchange, payers face a complex set of challenges in adopting FHIR. The move to FHIR is not just a compliance exercise – it’s a strategic transformation with high stakes. 

The “Rip and Replace” misconception 

A common myth is that adopting FHIR requires a complete overhaul of existing systems and workflows. This misconception can lead to unnecessary spending and disruption. In reality, a phased, strategic integration of FHIR into existing architectures is often more effective—and more sustainable. 

CMS-0057-F compliance 

Complying with CMS-0057-F is challenging for payers who must adopt real-time FHIR-based data exchange while still supporting legacy systems. The regulation’s tight timelines, combined with complex dual workflows, create operational strain and increase the risk of non-compliance, inefficiency, and provider dissatisfaction. 

Supporting dual workflows 

Many payers must maintain legacy processes for commercial lines of business while simultaneously implementing FHIR-based workflows for government programs or interoperability mandates. Managing both worlds increases the operational burden and introduces complexity into already strained systems. 

Operational inefficiencies 

Without a scalable FHIR implementation strategy, payers risk fragmented workflows, increased manual effort, and poor data integration. This can lead to rework, delays in decision-making, and missed opportunities for automation and analytics. 

Gaps in FHIR expertise 

Small to mid-sized payers may lack the internal available resources to build, scale, and maintain FHIR-based infrastructure. Recruiting or developing these capabilities can be time-consuming and expensive, especially under regulatory deadlines. 

Rising provider expectations 

Providers expect seamless, real-time electronic data exchange—especially for processes like prior authorization. Failing to meet these expectations can lead to provider dissatisfaction, delays in patient care, and strained payer-provider relationships. 

How Firely Server helps

Enables Incremental FHIR Adoption (Avoiding “Rip and Replace”) 

Firely Server supports modular integration, allowing payers to gradually embed FHIR capabilities into their existing systems—reducing disruption, preserving prior investments, and aligning with phased CMS-0057-F compliance timelines. 

Streamlining Compliance with CMS-0057-F 

Firely Server helps payers meet CMS-0057-F requirements with a scalable FHIR platform that enables real-time data exchange and seamless integration into existing systems. With built-in support for US Core and Da Vinci guides, it accelerates compliance, reduces the need for deep FHIR expertise, and improves efficiency across prior authorization and other key workflows. 

Supports Dual Workflows Across Business Lines 

With flexible data modeling and API-driven architecture, Firely Server enables simultaneous support for both legacy processes and FHIR-based workflows, helping payers meet federal mandates without compromising commercial operations. 

Improves Operational Efficiency with Scalable FHIR Infrastructure 

Firely Server reduces manual overhead through automation-ready FHIR APIs, high-performance data access, and seamless integration with existing clinical and administrative systems—streamlining prior auth and other workflows. 

Bridges FHIR Expertise Gaps with Built-In Compliance and Tooling 

Out-of-the-box support for US Core and Da Vinci implementation guides helps smaller payers accelerate adoption without needing deep in-house FHIR expertise, minimizing regulatory risk and shortening implementation timelines. 

Meets Provider Expectations for Real-Time Data Exchange 

Firely Server’s robust FHIR APIs support fast, standards-based data sharing—empowering payers to offer timely responses for prior authorization and other transactions, improving provider collaboration and patient care outcomes. 

Conclusion 

As the healthcare landscape continues to evolve, payers must move beyond viewing FHIR as a regulatory checkbox and embrace it as a foundation for long-term transformation. Firely empowers health plans to adopt FHIR in a way that is scalable, secure, and aligned with business goals – without the need for disruptive overhauls. Whether you’re streamlining prior authorizations, enabling payer-to-payer data exchange, or meeting CMS mandates, Firely provides the trusted infrastructure and expert support to accelerate your interoperability journey with confidence.