CAQH CORE: Delivering Value through Electronic Healthcare Attachments
Healthcare leaders have long worked to more closely align administrative and clinical systems. While many believe the capacity for greater interoperability is now within reach, data in clinical and administrative systems has remained siloed. The electronic exchange of attachments to communicate medical information and supplemental documentation between health plans and providers is an opportunity to change this in a significant way.
Electronic attachments open a line of communication between administrative and clinical systems and hold the key to unlocking the next level of interoperability by making the use of integrated data routine. Attachments provide health plans with vital information for adjudication of a subset of claims, prior authorizations, referrals, post-adjudication appeals, audits and other critical use cases.
In 1996, HIPAA mandated the adoption of an electronic standard for attachments, and the healthcare industry has been waiting for HHS action on this standard for many years. The extended wait for a federal attachment standard has fueled a sense of uncertainty, deterred vendor development of a standardized approach and resulted in varied electronic solutions and manual workarounds.
Source: 2018 CAQH Index
Through its HHS designation as the Operating Rule Authoring Entity for HIPAA-mandated administrative transactions including attachments, a key goal of CAQH CORE is to accelerate the adoption of electronic transactions and streamline communication of clinical information through the development of operating rules. CAQH CORE has engaged in a variety of work efforts to survey industry utilization and barriers to identify opportunities for greater uniformity and to educate and promote industry adoption of electronic attachments. In 2019, CAQH CORE launched operating rule development for attachments given the industry clamor for adoption and uniformity. Rule development will encompass priority use cases including claims, prior authorization and value-based payment.
For more information on how to get involved with the CAQH CORE Attachment Initiatives, email firstname.lastname@example.org.