CAQH CORE Directors Erin Weber and Bob Bowman will present at the HIMSS 2022 Conference in Orlando, FL. Their session "Mind the Gap: Attachments Operating Rules to Improve Business Processes" will take place on Thursday afternoon.

Presentation Summary

CAQH CORE is dedicated to engaging with industry leaders to standardize business processes across the revenue cycle for the benefit of patients, providers and health plans. An industry-wide transition to replace manual processes with electronic, real-time transactions is ongoing to reduce the cost of doing business in healthcare and meaningfully impact efficiency, productivity, and data quality.

Throughout a two-year CAQH CORE initiative, 150 individuals from over 50 organizations from across the industry gathered to guide the development of common approaches for the exchange of attachments to reduce administrative burden. This industry group identified and prioritized the creation of operating rule requirements to address prior authorization and claims as specific use cases.  The finalized rule requirements target key infrastructure requirements, exchange standards, and one of the most significant problem areas in the attachment's workflow process: reassociation of an attachment to the original prior authorization request or claim submission. In the absence of a HIPAA-mandated standard being named, these requirements provide the industry with direction on how to provide the information necessary to electronically send attachments uniformly and consistently. Along with the updated CAQH CORE Connectivity Rule, they serve as a bridge between existing and emerging standards.