The New CMS Compliance: What Every Payer Needs to Know

For payer leaders, compliance officers, and IT teams ready to unify disconnected data and meet the January 2027 CMS-0057 mandate.

Health plan operations run across systems that were never designed to work together. Claims live on one platform. Prior authorization decisions sit in another. Clinical data, pharmacy records, and appeals outcomes are distributed across a third, fourth, and fifth — with no single, continuous view of the member journey.

The result is predictable: manual coordination between disconnected tools, limited visibility into where a prior authorization actually stands, and compliance-critical steps like benefits verification, turnaround tracking, and audit logging happening at different points in different systems.

Every disconnection introduces delay. Every delay puts compliance at risk — at the exact moment CMS enforcement begins.

It is time to connect the compliance journey end to end.

This ebook shows how Innovaccer's Gravity platform brings payer data, prior authorization workflows, and FHIR API delivery into a single operational layer — turning a fragmented, high-risk process into a continuous, auditable flow ready for January 2027.

Inside, you'll find:

• The real cost of data and workflow fragmentation for payers
• How the five structural gaps surface in day-to-day operations — and how to close them
• How a unified data layer supports all four FHIR APIs from a single source of truth
• How AI-powered prior auth automation meets the 7-day and 72-hour mandates at scale
• What payers gain when compliance, operations, and audit readiness all connect

Download this ebook and see how a unified data-first approach turns fragmented payer workflows into a faster, auditable path to CMS-0057 compliance.

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