New CAQH CORE White Paper on Automating Prior Authorization

Paper highlights barriers to automation and a roadmap to a streamlined electronic process

July 2019

CAQH CORE has released a new white paper on automating prior authorization. The paper identifies six barriers to automation:

  1. Lack of integration between clinical and administrative systems.
  2. Lack of federally-mandated standards for attachments and clinical documentation.
  3. Limited availability of vendor products that readily support the standard transaction.
  4. The need for consistency in data content.
  5. State requirements for manual intervention.
  6. Lack of provider awareness.

The paper also summarizes industry work focused on improving the prior authorization process, including collaborative efforts that build on standards and operating rules to close automation gaps. For example, CAQH CORE has developed Phase IV and V Prior Authorization Operating Rules to establish common data and infrastructure requirements, and is testing new operating rules to support existing and emerging standards.

April Todd, SVP of CAQH CORE and Explorations, is presenting highlights from the white paper at the WEDI Summer Forum in Chicago. Read the white paper “Moving Forward: Building Momentum for an Automated Prior Authorization Adjudication Process” and the related press release.

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