CMS’s CMS-0057-F final rule makes one thing clear: electronic Prior Authorization (ePA) is no longer optional. By 2026, payers must support FHIR-based exchange of prior authorization requests and responses. 

The challenge isn’t what to do—it’s how to get there without disrupting existing systems and workflows. Firely Server provides a scalable, FHIR-native foundation for ePA, enabling compliance without costly “rip-and-replace” projects. 

The Problem for Payers

Payers face a perfect storm of regulatory pressure, operational complexity, and resource constraints as they prepare for CMS-0057-F:

• The rip-and-replace myth
  Vendors often push full system overhauls. Firely strongly disagrees. Ripping out everything is costly, disruptive, and unnecessary. 

• Dual-track operations
  CMS mandates apply to Medicare and Medicaid, while commercial accounts must continue with existing processes. That means supporting two sets of workflows. 

• Operational inefficiencies
  Without a flexible ePA strategy, payers risk manual work, higher rework rates, and lost opportunities to improve care quality. 

• Limited FHIR expertise
  Most small to mid-sized payers don’t have the in-house bench to build and maintain FHIR workflows. 

• Provider expectations
  Clinicians demand real-time, electronic workflows. Manual prior auth creates friction, delays, and dissatisfaction. 

The Upside of ePA with Firely Server

• Expose FHIR APIs without replacing core systems 
  Firely Server acts as a universal adapter, translating modern FHIR requests into formats your systems already use. 

• Simplify provider connectivity 
  Full support for Da Vinci Burden Reduction standards (CRD, PAS, DTR) lowers integration costs and reduces provider friction. 

• Move toward native FHIR at your pace 
  No big-bang cutover required. Firely supports phased adoption—connecting today’s workflows while preparing for tomorrow’s. 

• Automate for efficiency and transparency 
  Reduce manual review, accelerate turnaround times, and provide structured responses that keep providers informed. 

• Mandated FHIR APIs, ready to deploy 
  The Firely CMS Package includes all required FHIR APIs, plus expert-led implementation guidance. 

• Vendor-neutral integration 
  Firely Server works with any PA infrastructure, ensuring flexibility and avoiding lock-in. 

Why Firely?

• Standards-First
  We don’t just implement FHIR, we help shape it through HL7 and Da Vinci. 

• Deployment-Ready
  Firely Server supports cloud and on-prem, SMART on FHIR, and OAuth2 for fast, compliant deployment. 

• Incremental by Design
  Wrap your existing PA systems with FHIR APIs and phase in native FHIR processing at your own pace. 

• Vendor-Neutral
  Integrates with any infrastructure, giving you flexibility across Medicare, Medicaid, and commercial lines of business. 

Don’t Go It Alone

FHIR can be intimidating if you’re new to the technology. Firely’s expert team is ready to guide your implementation, provide staffing support, and ensure you hit the ground running.