Health Plans
EDI and FHIR transaction processing for health plans: the CMS-0057-F APIs, prior authorization, payer-to-payer exchange, and vendor concentration risk reduction, on a platform that never holds your members' data.
The Challenge
Health plans face a convergence of pressures: compliance mandates, rising administrative costs, provider network management complexity, and the need to use data for value-based care initiatives, all while managing the security risk of legacy data infrastructure.
Two of those pressures arrive at once: a compliance clock and a concentration problem. CMS-0057-F (the CMS Interoperability and Prior Authorization Final Rule) APIs are due January 1, 2027, and the vendor landscape is one in which the intermediaries handling member data are among the most attacked organizations in the sector.
Two Pressures at Once
The 2027 Clock
Four FHIR APIs, Patient Access, Provider Access, Payer-to-Payer and Prior Authorization, with compliance beginning January 1, 2027. Payer-to-payer is the hard one, because it depends on organizations outside your control. Material citing January 2026 is incorrect and has caused real planning error.
Concentration Is Now a Board Question
Plans are being asked, increasingly by their own boards, what happens when a data intermediary is compromised. The honest answer for most is: claims stop, remittances stop, and member data is exposed at a scale the plan did not choose. An intermediary that retains nothing changes the answer to that question structurally.
What Post-n-Track Does for Health Plans
Post-n-Track provides health plans with a comprehensive data sharing infrastructure that addresses all of these challenges simultaneously. Post-n-Track handles transaction and data requirements, use cases and real-time transaction processing, all through a single, zero-residency platform.
Health plans achieve regulatory compliance, reduced administrative costs, improved provider relations, and the AI-ready data infrastructure needed for value-based care, without replacing their core systems or existing vendors.
Transactions and Workflows That Matter
A plan touches every transaction from the payer side: claims in, remittances out, eligibility and status inquiries answered, authorizations decided. These are the pages the 2027 mandates and the concentration question turn on.
FHIR API Integration
A managed FHIR R4 bridge that meets CMS-0057 obligations without replacing existing EDI infrastructure.
Payer-to-Payer Interoperability
Two payers with no relationship finding, authenticating and matching a member. The FHIR API is the easy part.
278 Prior Authorization
System-to-system authorization requests and responses that replace portal and phone workflows.
270/271 Eligibility & Benefits Verification
Coverage and benefit detail returned to providers in real time, before care is delivered.
837 Claims
Inbound claims validated against your edits in flight, so what reaches adjudication is clean.
835 ERA Processing
Remittance delivered in a consistent format your providers can post without manual interpretation.
Frequently Asked Questions
What do health plans need for CMS-0057-F?
Four FHIR APIs, Patient Access, Provider Access, Payer-to-Payer and Prior Authorization, with compliance dates beginning January 1, 2027. Payer-to-payer is the hardest because it requires discovery, trust and member matching with organizations outside your control.
How do health plans reduce data intermediary risk?
By asking whether the intermediary needs to retain the data at all. Encryption and access controls protect a repository that still exists. An intermediary architected to retain nothing removes the repository, which bounds the blast radius of its compromise to transactions in flight.
- 20 years in operation
- 2,000+ healthcare organizations served
- 2026 MedTech Breakthrough Award Best Overall Healthcare Cybersecurity Solution
- Certified and accredited HITRUST · CAQH CORE · DirectTrust · SOC 2
- 100% U.S.-based Veteran-owned (SDVOSB)
Ready to talk through your use case?
Talk to a Post-n-Track specialist about your data challenges. A direct conversation, starting with what you need.