CMS Compliance — From Gap Analysis to Resolution

The CMS Interoperability and Prior Authorization rules represent a fundamental shift in how health plans manage data exchange. Compliance is not optional, and the penalties for non-compliance are significant. Our CMS Compliance service takes you from assessment through resolution — identifying gaps, building roadmaps, and overseeing implementation to ensure your organization meets regulatory requirements on time.

What We Deliver

• Regulatory Gap Analysis — Assess your current state against CMS-9115-F (Interoperability), CMS-0057-F (Prior Authorization), and related rules to identify compliance gaps
• Compliance Roadmap — Develop a prioritized, time-bound plan that addresses gaps within regulatory deadlines and your organization's resource constraints
• Implementation Oversight — Provide technical leadership and project oversight during API development, data mapping, and system integration work
• API Architecture Review — Ensure your FHIR API implementations meet CMS technical requirements for Patient Access, Provider Directory, and Payer-to-Payer exchange
• Testing & Validation — Design testing strategies that validate compliance across data content, API behavior, and operational workflows
• Audit Preparation — Document compliance evidence, prepare staff for CMS audits, and conduct readiness assessments

Related Services

For organizations that need hands-on API development support, our FHIR API Implementation service provides dedicated technical expertise in HL7 FHIR R4 API design and development.

Who We Serve

We work with healthcare payers — health plans, Medicaid MCOs, and Medicare Advantage organizations — navigating the evolving CMS regulatory landscape. Our 15+ years of healthcare technology experience means we understand the operational, technical, and organizational challenges that payers face in achieving compliance.