New CAQH CORE Operating Rules Improve How Plans and Providers Exchange Information Related to Eligibility and Supplemental Documentation

/PRNewswire/ -- CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors and government entities, today...

WASHINGTON, April 20, 2022 /PRNewswire/ -- CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors and government entities, today released new operating rules to improve day-to-day healthcare operations and how plans and providers exchange information related to benefits coverage and supplemental documentation. More than 88 percent of participating organizations approved adoption of these rules.

"The operating rules released today represent another step in improving the way plans and providers exchange information millions of times every day," said Tim Kaja, MBA, Senior Vice President, Optum Care and CAQH CORE Board Chair. "These rules will improve operations -- in administrative offices and at the point of care -- and will enhance the experience for all stakeholders."

New rules for supplemental documentation attachments
The new CAQH CORE Prior Authorization and Health Care Claim Attachments Operating Rules enable providers to send to health plans documentation to support a claim or prior authorization in a uniform, electronic format using industry standards. The exchange of attachments has been a longstanding industry challenge and these rules will lead to quicker coverage and payment decisions.