Every item on this page has a date and an owner.
Contract year 2027 brings the largest set of simultaneous changes a Medicare Advantage plan has absorbed in years. This page lists each one, the date it takes effect, who in the plan owns it, and what Vernier does about it. Written for the CIO, the compliance officer and the UM director.
What changes, and when.
| Change | Effective | Owner in the plan | How Vernier covers it |
|---|---|---|---|
| CMS-0057-F: four FHIR APIs in production (Patient Access, Provider Access, Payer-to-Payer, Prior Authorization) | Jan 1, 2027 | CIO, compliance | All four implemented against FHIR R4, US Core 6.1.0, CARIN BB 2.0 and Da Vinci PDex and PAS, with 42 automated conformance assertions passing. Details → |
| Standard prior-authorization decision window shortened from 14 days to 7; expedited stays 72 hours | Jan 1, 2027 | VP Medical Management, UM director | Determination due date computed from the shortened clock and carried on every request. The queue of authorizations about to breach, with an owner on each. |
| Annual public posting of prior-authorization metrics | Jan 1, 2027 | Compliance | The disclosure is published from the same data the queue runs on. |
| Eleven Star measures retired; the measure set contracts | CY2027 | Stars director | Every retired measure reweights the survivors. The analytics portal carries the CY2027 set so the plan can re-model. |
| C31 Depression Screening and Follow-Up added as a Star measure | MY2027 | Stars director, care management | Screening capture is an HRA and care-management workflow. Vernier HRA escalates PHQ-2 to PHQ-9; the analytics portal gates C31 correctly to measurement year 2027. |
| Special supplemental benefits for the chronically ill (SSBCI) must be publicly posted | CY2027 | Product, compliance | Member materials readiness module tracks the posting against CMS deadlines. |
| Part D redesign codified: no coverage-gap phase, $0 catastrophic cost sharing | CY2027 | Pharmacy, member services | Already shipped in the member portal's coverage and accumulator display. |
| CMS-HCC V28 risk model | In effect | Risk adjustment | Analytics, provider portal and FHIR are on V28, with the V24 number shown alongside for prior-year RAPS reconciliation. |
Summary of CMS rules as published. Validate applicability to your contracts with compliance counsel.
A plan that has not started is going to miss.
The APIs need production infrastructure, a consent model, attribution logic and a public metrics page. The seven-day clock needs a UM department that can see its own queue. Bids, ANOC production and Star strategy all sit inside the same window.
Vernier's FHIR service and analytics portal are built and demonstrable today. Deployment into your environment, or ours, is a configuration project rather than a build project.
Readiness conversation
Which of the eight items above does the plan own today, and which has no owner.
Deploy and connect
Stand up the FHIR service and the analytics portal on your adjudicated claims feed. Configure consent defaults and attribution.
In production
Four APIs live, the seven-day queue running, the metrics page ready to publish.
Questions to ask any vendor, including us
- Do you store Provider Access opt-out and Payer-to-Payer opt-in as two separate fields with two separate defaults?
- What does your prior-authorization endpoint do with a request it cannot approve automatically? If the answer is "deny", who issued the adverse determination?
- Are claims-derived diagnoses marked unconfirmed, with provenance, or asserted as a problem list?
- What status code does a resource outside the caller's compartment return?
- How many conformance assertions run against a booted server, and can I see them?
- Which Star measures retire in CY2027, and what does my measure set look like after they do?
Who owns January 1 at your plan?
Bring that person. Twenty minutes with Bruce: the four endpoints, the seven-day queue and the metrics page, running.