Health plans

X12 and CAQH CORE Webinar Series: Introduction to the 278 Transaction, Standard and Operating Rules

The ASC X12N Health Care Services Review – Request for Review and Response (278) is a paired transaction set. This transaction set is also known informally by other names, such as Referral or Prior Authorization. The 278 is used throughout the healthcare marketplace by providers to electronically submit prior authorization and referral requests. CAQH CORE Operating Rules for Prior Authorization help the industry effectively utilize the 278 transaction to further standardize and automate components of the prior authorization process.