Turn Your CMS Interoperability Mandate Into Operating Advantage
Taidou helps health plans and provider organizations move past the Prior Authorization API deadline — building one FHIR-based platform that also cuts administrative cost, closes quality gaps, and gets ahead of CMS-0062-P's drug prior authorization requirements.
A Collaborative Approach Across Payer & Provider Operations
We work with health plans and provider organizations that need to treat CMS-0057-F and CMS-0062-P as more than a compliance checkbox. Our team pairs regulatory and FHIR technical fluency with hands-on experience in utilization management, revenue cycle, and care operations — so the same investment that meets the mandate also reduces administrative cost and improves data quality.
- Regulatory roadmaps tailored to Payer, Provider, or delegated-risk operating models
- Cross-functional expertise spanning UM, appeals, provider services, and IT/API delivery
- Structured, governance-ready decisioning frameworks for auto-approval and disposition rules
- Value quantification methodology built for finance sign-off, not just directional estimates
CMS-0057-F — Interoperability & Prior Authorization
Requires Medicare Advantage organizations, state Medicaid/CHIP FFS programs, Medicaid managed care plans, CHIP managed care entities, and QHP issuers on the FFEs to implement five interoperability APIs: Patient Access, Provider Access, Provider Directory, Payer-to-Payer, and Prior Authorization (built on the Da Vinci CRD, DTR, and PAS implementation guides).
CMS-0062-P — Interoperability Standards & Prior Authorization for Drugs
Extends CMS-0057-F's electronic prior authorization and interoperability requirements to drugs covered under both medical and pharmacy benefits, proposes shorter decision turnaround times, adds FHIR endpoint/usage reporting, and updates required implementation guide versions.
Two Mandates, Two Operating Models — Advisory Built for Both Sides of the Transaction
Whether you're a Payer building the API infrastructure or a Provider adapting workflows around it, our offerings are scoped around where the compliance burden and the value opportunity actually sit.
Interoperability Platform Strategy
Design a shared FHIR data layer, API gateway, and unified consent & identity model — one foundation for all five APIs instead of siloed builds.
- Platform vs. point-solution business case
- Consent & attribution architecture
- Vendor / integrator selection support
Prior Auth API Enablement (CRD / DTR / PAS)
Stand up the Da Vinci-based prior authorization workflow so rules populate at the point of order and decisions return through the API, not a portal.
- Med policy codification for CRD/DTR
- PAS decisioning & UM system integration
- Multi-UM-system and delegate connectivity
Auth Disposition & PA Grid Governance
A structured, time-boxed workshop process to decide which PA codes can move to auto-approval — closing the gap to industry auto-approval commitments.
- Code-level ROI & risk scoring workbooks
- Business alignment & executive sign-off cadence
- UM system deployment handoff
Value Realization & Business Case Modeling
Finance-defensible estimates of administrative savings by function — Provider Service, UM Clinician, Appeals, Customer Service — with adoption-sensitivity ranges.
- Cost-center & FTE impact modeling
- Provider-adoption sensitivity analysis
- Program cost vs. budget tracking
Enterprise Value Expansion
Extend the platform built for compliance into Stars/HEDIS gap closure, risk adjustment, delegate insourcing, and payment integrity use cases.
- HEDIS/Stars real-time gap closure design
- Delegated UM insourcing feasibility
- Payment integrity & claims pre-validation
CMS-0062-P Drug PA Readiness
Get ahead of the proposed extension of prior auth interoperability to drugs — medical and pharmacy benefit — before requirements finalize.
- NCPDP SCRIPT / Formulary & Benefit gap assessment
- Medical vs. pharmacy benefit workflow mapping
- Decision-timeframe compliance readiness
EHR-Embedded Prior Auth Workflow
Integrate CRD and DTR into ordering workflows so payer rules and documentation requirements surface inside the EHR, not after the fact.
- CDS Hooks / SMART on FHIR integration scoping
- Order-time rule & questionnaire display
- PAS submission & status tracking
Provider Directory & Attribution Readiness
Clean and validate directory and attribution data so Provider Access API calls route correctly — and network adequacy reporting holds up.
- Directory data accuracy audit
- No Surprises Act alignment
- Attribution data governance
Multi-Payer Connectivity Strategy
A single integration approach for connecting to multiple health plans' Prior Auth and Patient/Provider Access APIs, instead of one-off builds per payer.
- Payer API inventory & prioritization
- Clearinghouse / integration-engine strategy
- Staff workflow & change management
Value-Based Care Data Exchange
Extend Payer-to-Payer and Provider Access data flows to ACOs and delegated-risk arrangements for longitudinal member data at the point of care.
- ACO / delegated-risk data-sharing design
- Shared-savings performance data pipelines
- Duplicate-request reduction
Appeals & Member Self-Service Enablement
Extend the Patient Access API's consumer model to real-time PA and appeals status, reducing call center volume and improving transparency.
- Real-time status & EOB self-service design
- Call center volume impact modeling
- Authorized-representative access
Compliance Program Design & Governance
Stand up the operating cadence, ownership model, and reporting needed to demonstrate CMS-0057-F / CMS-0062-P compliance on an ongoing basis.
- Compliance operating model & RACI
- API usage / metrics reporting to CMS
- Audit-readiness documentation
A Three-Year Path From Compliance to Competitive Advantage
We sequence engagements so the infrastructure built to meet the mandate keeps paying off well past the deadline.
Build the Platform
Stand up the shared FHIR data layer, unified consent & identity management, provider directory cleanup, and core API connectivity.
Go Live & Harvest
Meet the compliance deadline, then immediately extend into UM automation, auth disposition, and quality gap closure.
Monetize the Platform
Extend to value-based care partners, member self-service, predictive analytics, payment integrity, and CMS-0062-P drug PA.
Estimate the Directional Value of Auth Disposition
A simplified, illustrative model to help frame the conversation — not a substitute for a finance-validated business case, which Taidou builds as part of engagement.
Your Inputs
Adjust to see directional impactBased on your inputs, moving from the current to target auto-approval rate shifts this many reviews out of manual UM queues annually.
Illustrative only. Actual value depends on code-level risk, provider adoption, LOB mix, and current staffing model — the inputs a Taidou value-realization engagement quantifies in detail.
Built for Organizations Navigating Both Sides of the API
Regulatory & Technical Fluency
Deep, current understanding of CMS-0057-F, CMS-0062-P, and the Da Vinci/FHIR implementation guides underneath them — not a generic compliance overlay.
The Payer-Provider Bridge
Cross-functional teams who have sat on both sides of the transaction, so recommendations account for how the other party will actually respond.
Governance-Ready Frameworks
Structured, workshop-based decisioning models — like auth disposition reviews — that get executive sign-off and implementation-ready outputs, fast.