Prior authorization (PA) has long been one of the most burdensome and inefficient processes in U.S. healthcare — causing delays, provider friction, and unnecessary administrative cost

Whether you’re early in planning or racing toward the 2027 deadline, this eBook breaks down what’s required, what’s changing, and how to build a scalable architecture that reduces administrative burden, improves provider relationships, and positions your organization for future interoperability initiatives.

What you’ll learn

✔ The essentials of CMS-0057-F

Understand who’s impacted, what’s mandated, and the real deadlines you can’t afford to miss, including new decision timeframes, annual reporting requirements, and the January 1, 2027 API go-live date.

✔ How FHIR-based prior authorization actually works

A simple explanation of CRD, DTR, and PAS — and how they create an end-to-end, automated workflow that eliminates portals, faxes, and manual submissions.

✔ What payers must implement to comply and scale

From CDS Hooks to documentation templates to FHIR/X12 hybrid support, the guide outlines the core capabilities needed for CRD, DTR, and PAS.

✔ The architecture that avoids costly rip-and-replace projects

Learn how a modular FHIR layer lets you modernize incrementally, connecting legacy systems while preparing for future mandates like dQMs.

✔ A realistic roadmap to 2026–2027 compliance

Step-by-step phases with timelines, deliverables, testing milestones, and best-practice implementation priorities.

✔ The ROI of automation

See how switching to electronic prior authorization can cut costs by 98%, reduce pends, shorten decisions from days to hours, and improve provider satisfaction.

✔ How Firely helps payers accelerate compliance

Get an overview of Firely’s CMS-ready FHIR platform and modular components for CRD, DTR, and PAS, plus guidance from the creators of key parts of the FHIR standard.