Availity, a real-time health information network, and Onyx, a leader in FHIR-based interoperability, have partnered to deliver a comprehensive, out-of-the-box solution aimed at assisting health plans in meeting the requirements of the CMS-0057 Interoperability and Prior Authorization Final Rule.
The joint platform is designed to streamline compliance efforts, reduce administrative burdens, and prepare payer infrastructure for future regulatory and operational shifts. The CMS-0057 rule, finalized by the Centers for Medicare & Medicaid Services (CMS), mandates that impacted payers implement a suite of APIs and reporting capabilities by January 1, 2027. CMS estimates a 30-month timeline for implementation and testing to achieve full compliance.
With less than 18 months remaining until compliance deadlines, health plans face significant implementation timelines. The Availity-Onyx solution is supported by a team with extensive interoperability expertise, contributing to the definition of industry standards, and leverages a national payer-provider-vendor network. It aims to provide a proven, scalable pathway for health plans to not only meet compliance but also to drive value and return on investment through scaled FHIR interoperability.
Solution capabilities include FHIR server management, offering a flexible, secure, and cloud-agnostic FHIR operating system with a robust data transformation layer to standardize data into FHIR resources, alongside built-in support for CMS interoperability mandate compliance. Patient Access and Provider Directory APIs enable members to access claims, encounters, and clinical data via mandated FHIR APIs, conforming to the CARIN IG for Blue Button, and include a developer portal and app store for third-party integrations.
Prior Authorization APIs facilitate end-to-end authorization connectivity across Availity’s network of delegated Utilization Management/Health Information Technology (UM/HIT) vendors, providers, and health plans to transform the electronic prior authorization experience. A Payer-to-Payer API and Connectivity Hub supports the sharing of clinical, claims, and prior authorization data, enabling secure, real-time data exchange between health plans and across the Availity Payer-to-Payer Connectivity Hub. Additionally, a Provider Access API and Connectivity Hub ensures mandate compliance, allowing providers to securely and efficiently retrieve patient-specific data directly from the health plan and via Availity’s Provider Connectivity Hub.
Mark Scrimshire, Chief Interoperability and Security Officer at Onyx, stated that the partnership combines capabilities across their respective platforms to enable health plans to meet these mandates with confidence. He added that the collaboration seeks to unlock long-term value through automation, interoperability, and improved provider collaboration. Sean Barrett, Chief Product Officer at Availity, noted that the solution is designed to extend beyond compliance by embedding FHIR-native APIs and real-time data exchange into payer workflows, laying a foundation for a more connected, efficient, and patient-centered healthcare system.
The Availity-Onyx solution offers accelerated compliance through out-of-the-box support for all CMS interoperability mandates, ensuring fast, seamless adherence. Its national network aims to eliminate costly point-to-point integrations and accelerate adoption among stakeholders. The platform’s proven scalability, being cloud-agnostic and FHIR-native, minimizes internal IT burden while offering flexibility to scale with evolving regulatory and business needs. Seamless integration is supported by an API-first architecture, SMART-on-FHIR authentication, and robust data transformation capabilities.
Trusted expertise stems from deep experience in FHIR, HL7, and DaVinci workgroups, with leadership in major federal interoperability initiatives. Robust reporting features include real-time dashboards and CMS-compliant metrics, providing actionable insights, transparency, operational oversight, and continuous improvement opportunities.
Availity is a health information network that facilitates the exchange of clinical, administrative, and financial information between payers and providers. It serves as a real-time health information network, developing automated and interoperable solutions that foster collaboration across the healthcare ecosystem. Availity connects to over 95% of payers, more than 3 million providers, and over 2,000 trading partners.
Onyx specializes in health data interoperability, providing standards-based, flexible, and cost-effective solutions for data access, use, and trust. Its technology supports workflows with secure, scalable architecture, and its industry expertise and partner network assist payers and providers in connecting faster, reducing costs, and navigating evolving regulations.
