The Clock is Ticking

CMS-0057-F has made 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. For many organizations, the real challenge is not 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 while avoiding costly “rip-and-replace” projects.

The Upside of Electronic Prior Authorization for Payers

1. Expose FHIR APIs without replacing core systems
   
   Firely Server enables payers to accept FHIR-based prior auth requests while continuing to process them through existing utilization management (UM) and claims systems. Think of Firely Server as a universal adapter: it plugs modern requests into your current environment, translating them into the formats and workflows you already use.
   
   How does it work? Firely Server connects to your existing workflows using flexible integration options, from APIs to its plugin framework, so your current business rules, intake queues, and decision engines remain intact. You get the benefits of FHIR-based interoperability on the outside, while your trusted processes continue to run on the inside.
   
   
2. Simplify provider connectivity
   
   Firely Server fully supports the Da Vinci Burden reduction standards: CRD surfaces payer documentation and coverage rules at the point of order, PAS bridges FHIR and X12 so providers can submit prior auth requests electronically. It’s like moving from a dozen custom power cords to a single outlet: providers connect once, and translation happens behind the scenes, lowering integration costs and reducing provider friction.
   
   
3. Move toward native FHIR at your pace
   
   Firely Server doesn’t force an all-or-nothing shift. You can continue processing requests through existing systems today, then gradually adopt native FHIR. Think of it as building a two-lane bridge: one lane connects today’s workflows, the other prepares for tomorrow’s. You can shift traffic gradually, testing and learning along the way, instead of betting everything on a single cutover. This phased approach gives you full control over timing, scope, and cost.
   
   
4. Automate for efficiency and transparency
   
   Even before full ePA maturity, Firely Server enables automation that reduces manual review, accelerates turnaround times, and provides structured responses back to providers. That means fewer staff hours spent chasing documents, faster decision-making, and clearer communication with providers.
   
   Think of it as turning on the GPS in your workflow: instead of navigating blind with paper and faxes, both payers and providers can see where a request stands, what’s missing, and when it will be resolved. Built-in logging, analytics, and validation also give payers the visibility they need to track performance, demonstrate compliance, and identify opportunities for continuous improvement.

Why Firely?

• Standards-first: Firely doesn’t just implement FHIR, we help shape it. As active contributors to HL7 and Da Vinci, we ensure Firely Server stays aligned with evolving regulations like CMS-0057-F, so you can address the challenge of unclear and shifting mandates.

• Deployment-ready: Firely Server can be deployed on cloud or on-premises, with full support for SMART on FHIR and OAuth2. That means you can stand up CMS-compliant APIs quickly, without waiting on large-scale IT overhauls.

• Incremental by design: Unlike “rip and replace” vendors, Firely Server wraps your existing PA systems with FHIR APIs. Over time, you can phase in native FHIR processing at your pace, protecting your prior investments.
  

• Vendor-neutral: Firely Server integrates with any PA infrastructure, homegrown or vendor-supplied, ensuring you’re not locked in. That flexibility is critical when balancing Medicare/Medicaid mandates with commercial workflows.