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CAQH CORE Backs Industry Collaboration to Improve Prior Authorization Process

Last month, the CAQH CORE Board submitted an open letter in support of the Consensus Statement on Improving the Prior Authorization Process, which shares many CAQH CORE goals, such as improved transparency and communications, continuity of patient care and automation and efficiency.

Committed to collaborating with industry stakeholders, CAQH CORE is eager to work with the statement’s authoring organizations, which include the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP), American Medical Association (AMA), American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA).

The 2017 CAQH Index found that healthcare provider and health plan adoption of standard prior authorization transactions was only eight percent--one of the lowest adoption rates of all transactions measured in the report. The proportion of prior authorization transactions conducted using that standard actually declined by more than 10 percentage points in comparison to the 2016 CAQH Index. However, automating prior authorization could result in savings of $6.84 per transaction.

CAQH CORE has been working to enhance automation through the Phase IV CAQH CORE Operating Rules, which set industry expectations for how prior authorization data should be exchanged with requirements for response times, connectivity, acknowledgement of requests and real time and batch processing. When finalized, Phase V CAQH CORE Operating Rules will ensure electronic prior authorizations contain critical information needed by providers and health plans to reduce the need for manual follow-up.

Read the full CAQH CORE open letter to the authors of the Consensus Statement on Improving the Prior Authorization Process here.