AWS HealthLake now supports CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requirements

AWS HealthLake now provides native support for healthcare payers to comply with the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This rule requires Medicare Advantage organizations, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers to implement four standardized FHIR-based APIs by January 1, 2027.

New capabilities

Patient Access API

• CARIN IG for Blue Button® 2.1.0 — enables patients to access their claims, encounter data, and prior authorization information through third-party applications

• SMART App Launch 2.0.0 — provides secure, standards-based authorization for patient-facing applications

• DaVinci PDex Drug Formulary 2.1.0 — allows patients to query drug coverage information

• API use metrics collection — supports the annual reporting requirement for aggregated, de-identified Patient Access API usage data

Provider Access API

• CARIN IG for Blue Button® 2.1.0 — enables sharing of patient claims and encounter data with in-network providers

• DaVinci PDex 2.1.0 — supports payer-to-provider clinical data exchange

• DaVinci PDex Drug Formulary 2.1.0 — provides drug formulary information to treating providers

• Consent management integration — supports patient opt-out workflows and provider attribution through integration with AWS services

Payer-to-Payer API

• CARIN IG for Blue Button® 2.1.0 — facilitates claims and encounter data exchange between payers

• DaVinci PDex 2.1.0 — supports clinical data exchange across payer boundaries

• $bulk-member-match operation — enables payers to identify shared members at scale for data exchange, supporting the requirement to request patient data from previous payers within one week of coverage start

• $bulk-member-match status tracking — provides asynchronous status polling for large-scale member matching operations