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Prior Authorization Management

Automate prior authorization submissions and achieve CMS-0057 compliance. Built for the 72-hour turnaround mandate with FHIR R4 native architecture.

The 2026 Mandate

The Regulatory Cliff is Coming

The CMS-0057 Interoperability and Prior Authorization Final Rule requires payers to implement:

  • 72-hour turnaround for urgent prior authorization requests
  • 7-day turnaround for standard requests
  • FHIR R4 APIs for electronic prior auth submission
  • Real-time eligibility and authorization status checks

Compliance deadline: January 1, 2026 (Medicare Advantage) | January 1, 2027 (Medicaid)

2026

CMS-0057 Compliance Deadline

Current State

Manual prior authorization processes take hours per request. Staff spend endless time on phone holds, faxes, and portal logins. Delays mean delayed care and patient dissatisfaction.

  • 35+ minutes per auth request
  • Manual payer portal navigation
  • No visibility into auth status
→

With Auth-Pilot

AI-powered automation handles the entire prior auth workflow. Real-time payer rules engine validates medical necessity before submission. Full visibility and tracking throughout.

  • 5 minutes average submission time
  • 85% auto-approval rate
  • Real-time status tracking
Powered by Auth-Pilot

How It Works

1

Detect

AI identifies when prior auth is required based on procedure, payer, and patient coverage.

2

Validate

Real-time rules engine validates medical necessity against payer-specific criteria.

3

Submit

FHIR-based submission to payers with complete clinical documentation attached.

4

Track

Real-time status updates with automated follow-up on pending requests.

Auth-Pilot

FHIR R4 Native • CMS-0057 Ready

Capabilities

Auth-Pilot Features

  • FHIR R4 Native: Built from the ground up for CMS-0057 compliance
  • Payer Rules Engine: Real-time access to payer-specific auth requirements
  • Medical Necessity AI: Validates requests before submission
  • Auto-Attachment: Pulls relevant clinical documentation automatically
  • Status Dashboard: Track all pending, approved, and denied auths
  • Appeal Integration: Denied auths flow directly to Denial Intelligence
85%
Auto-Approval Rate
5 min
Average Submission Time
72hr
CMS-0057 Ready
100+
Payers Supported

Ready for the 2026 Prior Auth Mandate?

See how Auth-Pilot can prepare your organization for CMS-0057 compliance.

Schedule Demo Take Readiness Assessment