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CAQH CORE: Delivering Value through Electronic Healthcare Attachments

Attachments refer to the exchange of patient-specific medical information or supplemental documentation to support an administrative healthcare transaction and are a bridge between clinical and administrative data. However, the attachments workflow remains primarily manual and immensely burdensome. The main pain point often cited among industry is a lack of mandated attachments standards. Over the years, the extended wait for federal attachment standards has fueled a sense of uncertainty, deterred the development of a standardized approach, and resulted in varied electronic solutions, manual workarounds, and differing technological capabilities.

To support a more uniform, electronic approach, CAQH CORE Participants developed the CAQH CORE Attachments Operating Rules which include common specifications to support the exchange of attachments and additional documentation using existing and emerging standards.

CAQH CORE Attachments Operating Rules

As a result of a prioritized effort by over 100 CAQH CORE Participating Organizations, the CAQH CORE Attachments Operating Rules were approved and published in 2022 to support the Prior Authorization and Health Care Claims workflows (see the linked Prior Authorization and Health Care Claims webpages for the published Attachments Operating Rules). The CAQH CORE Attachments Operating Rules specify common infrastructure, data content, and connectivity requirements to establish consistent expectations for the exchange of attachments, providing immediate value to the industry.

The rules establish a common set of standard agnostic specifications to support the exchange of attachments sent with the X12 275 transaction and without using the X12 275 transaction (e.g., HL7 FHIR Resources, HL7 C-CDA, etc.). By supporting both X12 and non-X12 exchanges of attachments, the rules offer flexibility to an industry in transition and ensure continued interoperability regardless of where an entity may fall on the technological spectrum.

Continued Efforts to Increase Electronic Adoption and Automation of Attachments 

CAQH CORE will continue to apply its integrated model and continually measure the impact of the attachments operating rules, including maintenance and updates to meet evolving business needs, and address new standards released. Through CORE Certification and the CAQH CORE Pilot & Measurement Initiative, CAQH CORE plans to measure the impact of establishing consistent expectations around the exchange of attachments to ensure the attachments operating rules support industry organizations at varying stages of maturity along the standards and technology adoption curve.

For more information on how to get involved with the CAQH CORE Attachment Initiatives, email