CAQH CORE Prior Authorization & Referrals Operating Rules

The Prior Authorization & Referrals Operating Rules standardize key components of the prior authorization process, including attachments sent to support a prior authorization request, closing the gaps in electronic data exchange to move industry towards a fully electronic end-to-end workflow.

Complete Set of Prior Authorization & Referrals Operating Rules

CAQH CORE Prior Authorization & Referrals (278) Infrastructure Rule vPA.3.0

CAQH CORE Prior Authorization & Referrals (278) Data Content Rule vPA.1.0

CAQH CORE Prior Authorization & Referrals Web Portal Rule vPA.1.0

CAQH CORE Attachments Prior Authorization Infrastructure Rule vPA.1.0

CAQH CORE Attachments Prior Authorization Data Content Rule vPA.1.0

Additional Resources

  • CAQH CORE Connectivity: Visit the CAQH CORE Connectivity webpage for more information on which version of CAQH CORE Connectivity is required for implementation with these rules.
  • CORE Certification/Endorsement: Learn more about CORE Certification and CORE Endorsement for the Prior Authorization & Referrals Operating Rules by visiting the CORE Certification webpage.
  • Resource Library: Visit the Resource Library to access FAQs, Analysis & Planning Guides, the CAQH CORE Master Companion Guide, webinars, and more to support implementation of the CAQH CORE Operating Rules.

For more information about the Operating Rules process or CORE Certification, contact CAQH CORE at CORE@caqh.org.

Type
Audience
CAQH Program