New Prior Authorization Process

What is CMS‑0057‑F?

The CMS‑0057‑F rule, released in early 2024, requires health plans to use technology to make prior authorization faster and easier. Instead of relying on phone calls, faxes, or separate payer websites, payers must support electronic data sharing.

Alliance Health is meeting this requirement by using secure electronic connections (APIs) to support prior authorization requests for Jiva and other services. This will be available in July 2026.

What does this mean for you as a provider?

Simply put, this change makes prior authorizations less manual, more transparent and faster.

How it works

• Less paperwork and phone calls
  Prior authorizations can be sent and received electronically, reducing the need for faxes, calls or logging into multiple payer portals.
• Works inside your EHR
  You can submit and track prior authorization requests directly through your electronic health record system instead of switching between systems.
• Faster updates
  You can see real‑time updates on the status of a request—whether it’s received, pending, or approved—without having to follow up.

Why is this helpful?

• Less administrative work
  Office staff spend less time submitting, checking and following up on prior authorizations.
• Quicker decisions
  Faster communication between providers and payers helps get patients approved for care sooner.
• Clear visibility
  You can easily see where a request stands at any time, reducing uncertainty and delays.