By Payers, For Payers: New Resource Helps Payers Achieve CMS-0057-F Compliance

(Vienna, VA – April 15, 2025) – The Sequoia Project, a leading non-profit focused on advancing healthcare interoperability, is pleased to publish the “Payer-to-Payer Compliance Readiness Checklist.” This checklist is designed to help payers assess their readiness for compliance with the payer-to-payer components of CMS-0057-F, a critical regulation for improving data sharing and interoperability in healthcare.

Implementation Resource for Payer Organizations

Developed by Interoperability Matters’ Payer-to-Payer FHIR® API Implementation Workgroup, the readiness checklist serves as a resource for any payer seeking to implement the Centers for Medicare & Medicaid Services (CMS) regulation. This editable checklist provides an easy-to-use framework that helps identify both explicit and implicit regulatory and operational requirements, ensuring payers are well-prepared to meet compliance standards.

“The Payer-to-Payer FHIR API Implementation Workgroup is a collective national effort,” said Mariann Yeager, chief executive officer of The Sequoia Project. “It is important payer interoperability is prepared for the upcoming CMS deadline.”

Typically, patients may opt to change their health insurance companies, i.e., payers, on an annual basis. The CMS regulations are meant to ensure that the exchange of information between the previous and new payers accompanies the switch. For payers, the mandated interoperability changes provide opportunities to improve member satisfaction, streamline operations, and enhance care continuity.

“There are less than 20 months left until the regulation goes into effect on Jan. 1, 2027,” said Nancy Beavin, director provider connectivity at Medica and co-chair of the Payer-to-Payer Workgroup. “The checklist is an invaluable resource for payers navigating the complexities of CMS-0057-F on a deadline.”

Supporting Payers in Achieving Compliance

The new checklist complements existing efforts and initiatives in the field by guiding payers step-by-step through the essential operational and regulatory considerations of CMS-0057-F. Although the initial release of the checklist focuses primarily on business and operational readiness, it provides the necessary foundation for future technical implementations.

“The goal of this regulation is to improve continuity of care for patients when they change their health plans,” said Robert Oakley, strategy and interoperability lead at Evernorth Health Services, and co-chair of the Payer-to-Payer Workgroup. “This checklist makes it easier for payers to facilitate the payer-to-payer exchange.”

Get Involved and Stay Informed

Interested in working with others to achieve payer-to-payer compliance with CMS-0057-F? If you are interested in participating in the Payer-to-Payer Workgroup, contact interopmatters@sequoiaproject.org to join the next meeting on April 15 from 2-3:30 p.m. Eastern. The first three workgroup meetings are complimentary for non-members of The Sequoia Project.

You can help in this collective effort to meet the compliance deadline by spreading the word to colleagues. For more information about the “Payer-to-Payer Compliance Readiness Checklist,” please visit our website or email InteropMatters@sequoiaproject.org.

Visit www.sequoiaproject.org for additional resources and updates on the Interoperability Matters program.

###

About Payer-to-Payer FHIR® API Implementation Workgroup

The Sequoia Project Interoperability Matters Payer-to-Payer FHIR® API Implementation Workgroup charge is to develop actionable business, inter-organizational governance, and operational best practices to achieve interoperable data exchange among and between payers using HL7® technical requirements.

This workgroup operates under the authority and guidance of The Sequoia Project Board and Interoperability Matters Steering Committee. It actively seeks input from a wide range of stakeholders and subject matter experts, when appropriate. The workgroup is organized and operated in a manner that is compliant with applicable antitrust laws, and its deliberations are confined to topics that are consistent with these legal requirements.