Auth57 Cafe

Stop chasing PDFs.
The rules just changed again.

Prior authorization lookups eat hours a day — every payer hides the answer in a different PDF or portal, and the rules change without notice.

But we've got you.

Fast lookups, full clinical context, and the real next step — on any phone, tablet, or desktop. No months-long integration into the UM system you're already stuck with.

Start Cafe — $99/mo →See a live demo

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1 · TYPE THE QUESTIONNew JerseyMedicaid · GLP-1 (weight loss)0.4sAVG LOOKUP2 · GET THE VERDICTNJGLP-1TXMRICAHumiraLIVENJ · MEDICAIDVERDICTWegovysemaglutide · GLP-1 weight-lossPA REQUIREDSOURCE · VERIFIED 2026-04-01njmmis.com / pdl / glp1.pdfNEXT STEPSubmit to enrollee's MCODocument prior treatment failure.CONFIDENCE98% · SOURCED3 · SOURCE-LINKED · DONE
10,402
Verified PA rules
51
States covered
6
Program types
< 1s
Average lookup time
The rules that built this category

Two CMS mandates rewriting prior authorization.

Cafe keeps your lookups in sync with both — and surfaces the moment either rule moves.

CMS-0057-F
Final Rule · In force

Electronic prior authorization, mandated.

FHIR-based PA APIs across 14 service categories. Applies to Medicaid, CHIP, Medicare Advantage, and federal-exchange QHPs — every plan in your book of business.

API deadline
Jan 1, 2027
— days left
CMS-0062-P
Proposed · Comment open

Drug-benefit PA, pulled in next.

Extends electronic PA to 20 drug classes under the medical benefit — immunomodulators, oncology injectables, specialty infusions, biosimilars.

Proposed deadline
Oct 1, 2027
— days left
Coverage you can audit

Every state, every program — one verdict per query.

10,402 verified rules across all 51 jurisdictions. Six program types. Twenty drug classes. The six WISeR pilot states under active CMS enforcement get the highest verification cadence.

PA requiredNo PAGold-card may applyWISeR pilot
AKMEWAMTNDMNWIMINYVTNHORIDWYSDIAILINOHPANJCTCANVUTCONEMOKYWVVAMDDEAZNMKSARTNNCSCDCHIOKTXLAMSALGAFLMARI51 STATES · 6 PROGRAMS · 10,402 RULES
What your team sees

The answer, not the research.

Every lookup returns a verdict, PA type, submission target, clinical-doc requirements, and turnaround — pulled from verified state sources. Confidence-scored. Source-linked. Continuously updated.

New Jersey · Medicaid FFS
GLP-1 — weight loss
PA Required
PA type
Full
Submit to enrollee's MCO. Step therapy required — document prior treatment failure.
High confidenceVerified 2026-04-01Source →
Texas · Medicaid · MCO
Inpatient — medical
PA RequiredGold Card may apply
PA type
Full
State gold card law (HB 3459) may exempt credentialed providers from the PA requirement. Verify provider eligibility before submitting.
High confidenceVerified 2026-04-10Source →
California · Medicaid · MCO
Metformin — diabetes
No PA Required
Preferred formulary placement. Proceed without authorization.
High confidenceVerified 2026-03-15Source →
Not just the verdict

When next steps exist, we show you.

Other tools tell you PA is required. When actionable guidance exists — what to gather, where to submit, how long it takes — Cafe surfaces it so your UM team can act immediately.

Start Cafe — $99/mo →
What to do nextOhio · Medicaid MCO · Biologics
1
Gather clinical documentation
Diagnosis confirmation and prior treatment history
Lab results within 90 days (CBC, LFTs, inflammatory markers)
Documentation of inadequate response to conventional therapy
2
Submit PA request
Submit to: enrollee's MCO plan
Federal protection applies: CMS-0057-F electronic PA mandate
3
Expected turnaround
Authorization valid: 180 days
Standard: 14 days
Expedited: 72 hours
The business case

$5.18 saved per lookup.

CAQH data shows manual PA costs your team $10.97 per authorization. Electronic lookup drops that to $5.79. At 500 lookups per month, Cafe pays for itself ten times over.

$10.97
Manual PA cost per request
$5.79
Electronic lookup cost
$5.18
Saved per lookup
10×
ROI at 500 lookups / mo
What's included

Everything your UM team needs.

Instant PA lookup

Search by state, program, drug class, or service category. Results in under a second — no logins, no phone queues.

CMS-0057-F + CMS-0062-P ready

Every rule verified against both mandates. Confidence-scored, source-linked, updated continuously as regulations change.

Drug-class coverage

GLP-1s, biologics, oncology injectables, immunomodulators — 20 drug classes across all 51 states and 6 programs.

Team seats included

5 seats out of the box. Every seat gets full access — no per-feature charges, no usage caps on lookups.

Gold-card detection

Texas HB 3459 and similar state exemptions surface automatically when a credentialed provider may be PA-exempt.

WISeR-state data depth

Highest verification cadence in the six WISeR pilot states — AZ, NJ, OH, OK, TX, WA — under active CMS enforcement.

Simple pricing

One plan. No surprises.

Unlimited lookups. All states. All programs. Cancel anytime.

Cafe
$99/month

All states · all programs · all drug classes · cancel anytime

  • Unlimited PA lookups
  • All 51 states + DC
  • CMS-0057-F + CMS-0062-P verified
  • 20 drug classes + 14 service categories
  • Next steps for every rule
  • Gold-card law detection
  • Watch alerts for your states
  • 5 team seats included
Start Cafe — $99/mo →
Compare all plans →
CMS-0057-F deadline · January 1, 2027

Your UM team deserves better than fax machines.

Start with 5 seats. Get your team live in under ten minutes. Or take the demo for a spin first — it runs on the same data.

Get started — $99/mo →Try the demoBook 15 min