Frequently Asked Questions - VII. CAQH CORE Attachments Prior Authorization Data Content Rule

How was the list of common reference data for reassociating an X12 275 and an X12 278?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:32
How was the list of common reference data for reassociating an X12 275 and an X12 278?

The common reference data lists represent commonly available data that, after several reviews, the Attachments Advisory Group and Attachments Subgroup participants (including providers, health plans, and vendors) ranked most useful in assisting document management systems with reassociation of an attachment to its original prior authorization request.

NOTE: Providers are not required to include the reference data listed in the rule but are encouraged to include all data elements that are readily available. Additionally, the lists of data elements in the rules are not prohibitive or exhaustive.

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If a provider does not send all data elements listed in the CAQH CORE Attachments Prior Authorization Data Content Rule to assist with reassociation, can the health plan request that the provider send the data elements listed in the rule?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:33
If a provider does not send all data elements listed in the CAQH CORE Attachments Prior Authorization Data Content Rule to assist with reassociation, can the health plan request that the provider send the data elements listed in the rule?

No. The list of data elements is recommended to assist with reassociation. The data elements should only be sent, if available, to the provider at the time of submissions. The lists of data elements in the rules are not prohibitive or exhaustive.

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Will an ‘Auth # ID’ be required at the time the X12 275 attachment or additional documentation is sent?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:33
Will an ‘Auth # ID’ be required at the time the X12 275 attachment or additional documentation is sent?

No. The CORE-required Minimum Data Elements regarding labels and descriptions indicate that the data could be originating within the provider’s system or the payer’s system. As such, if an Auth ID is not available when the attachment is sent, it is not required.

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Do the CORE-required Minimum Data Elements specified in the non-X12 method section of the CAQH CORE Attachments Prior Authorization Data Content Rules need to correspond to X12 data elements?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:34
Do the CORE-required Minimum Data Elements specified in the non-X12 method section of the CAQH CORE Attachments Prior Authorization Data Content Rules need to correspond to X12 data elements?

No. The data does not need to conform to X12 data element naming conventions and as such, do not need to correspond to those X12 data elements as it is not an X12 transaction.

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Are all the data elements included in the CORE-require Minimum Data Elements specified in the non-X12 method section of the CAQH CORE Attachments Prior Authorization Data Content Rules required if the information is not available to the provider?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:35
Are all the data elements included in the CORE-require Minimum Data Elements specified in the non-X12 method section of the CAQH CORE Attachments Prior Authorization Data Content Rules required if the information is not available to the provider?

No. If the information is not available, it is not required.

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If an entity has an internal management system that is not used for attachments, is it still subject to the 64 MB size minimum?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:35
If an entity has an internal management system that is not used for attachments, is it still subject to the 64 MB size minimum?

No. If an entity’s internal document management system is not used for holding and processing attachments, it is not subject to the 64 MB minimum size requirement.

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Can multiple attachments be sent within a single instance of the X12 v6020 275 transaction?
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Does the requirement that entities must support a minimum of 64MB apply to the transaction or per loop?

Submitted by tfuchs@caqh.org on Mon, 04/18/2022 - 10:36
Does the requirement that entities must support a minimum of 64MB apply to the transaction or per loop?

The requirement to support a minimum of 64MB applies to the entire content of the BDS segment of the X12 v6020 275, not per loop. Please note, this requirement is only a floor, not a ceiling, meaning that organizations can choose to accept more than 64MB of data. Organizations must accept a minimum of 64MB.

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