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
DaVinci Data Export — supports bulk FHIR data export aligned with the DaVinci implementation guide for efficient payer-to-payer data transfer
Group Discovery APIs — enables auto-discovery of resource types available for export, streamlining payer-to-payer integration
Consent management integration — supports patient opt-in workflows required for payer-to-payer data exchange
Prior Authorization API
DaVinci Coverage Requirements Discovery (CRD) 2.1.0 — allows providers to query whether prior authorization is required and discover documentation requirements for items and services
DaVinci Documentation Templates and Rules (DTR) 2.1.0 — supports compilation of necessary documentation to accompany prior authorization requests
DaVinci Prior Authorization Support (PAS) 2.1.0 — enables end-to-end electronic prior authorization including submission, status tracking, and decision communication via FHIR APIs
SMART App Launch 2.0.0 — provides secure authorization for prior authorization workflow applications
Prior authorization metrics support — enables payers to collect and expose required metrics including approval rates, denial rates, appeal outcomes, and average decision timeframes
AWS HealthLake is a HIPAA-eligible service. Customers are responsible for determining their own compliance obligations under CMS-0057-F and should consult with legal and compliance counsel regarding their specific requirements.
AWS HealthLake is available in the US East (N. Virginia), US East (Ohio), US West (Oregon), Asia Pacific (Mumbai), Europe West (London), Europe (Ireland), and Asia Pacific SouthEast (Sydney) Regions. Visit the AWS Region Table to see all the regions.
To learn more, see the AWS HealthLake product page and AWS HealthLake Developer Guide.