Case Study: U.S. healthcare clearinghouse achieves CMS-0057-F FHIR prior authorization readiness with CleverDev Software

U.S. Healthcare Clearinghouse launches FHIR prior authorization in 6 months with CleverDev Software

A U.S. healthcare clearinghouse faced the challenge of preparing for CMS-0057-F compliance, as its prior authorization workflows were inconsistent across fragmented internal systems, making it difficult to provide reliable FHIR APIs without disrupting existing operations. The clearinghouse partnered with CleverDev Software to design and implement a FHIR-based interoperability enablement layer.

CleverDev Software delivered a solution that included a FHIR Prior Authorization API layer and an interoperability bridge, built using an event-driven architecture. This allowed the legacy systems to be integrated without modification, creating a pragmatic compliance layer. As a result, the clearinghouse achieved a production-ready system within six months, which improved payor visibility, reduced manual reconciliation efforts, and enabled faster integration with pilot payors.