CMS-0057-F Interoperability, Part 1

CMS-0057-F Interoperability: The Payer Advantage

From Mandate to Momentum:
Why Interoperability is No Longer Optional for Payers

If you are a payer still treating interoperability as an IT problem instead of a strategic imperative, it is time to pay attention.

With CMS-0057-F now finalized, interoperability is no longer about checking a compliance box—it’s about transforming how healthcare data flows across the ecosystem. For payers, this rule represents a critical opportunity to take ownership of member experience, provider collaboration, and data exchange.

Let’s be clear: the mandate isn’t the real news. The real news is the business opportunity.

CMS-0057-F requires payers to implement and maintain standardized APIs that allow patients and providers to seamlessly access data. But done well, these APIs can become the foundation for:

• Improving member satisfaction by reducing friction around access to records and care navigation
• Streamlining prior authorization processes that often delay care and frustrate providers
• Enabling better risk stratification and quality improvement efforts across your population

Case in point: One regional health plan in the Midwest leveraged their CMS Patient Access API as the backbone of a mobile app that lets members not only view their claims and encounter data, but also access personalized care recommendations and wellness benefits. What started as a compliance project turned into a key member engagement tool with 3x app adoption in under 12 months.

The takeaway? CMS compliance isn’t the ceiling—it’s the floor.

Payers who move quickly and thoughtfully can turn regulatory requirements into competitive advantages. But that means investing in platforms that make interoperability seamless and secure across systems.

AaNeel’s Health Access Cards, debuting at AHIP, offer a member-first approach to interoperability—enabling payers to connect patients, providers, and data through a single point of access.

At AaNeel, we help payers stand up APIs that don’t just meet CMS standards—they elevate the entire experience.

Next Up in Part 2: We’ll look at how payers can strengthen their value-based care partnerships through better data exchange.

Attending AHIP 2025?
Join us at Booth #1406 to explore how AaNeel’s Health Access Cards and integrated solutions help payers move beyond compliance and unlock true interoperability. Let’s build a smarter future of connected care—together.

Want more? Download the full CMS Interoperability White Paper and explore how your organization can lead the future of connected care. 📄 Download Now