CORE

Enhancing Industry Interoperability: CAQH CORE Connectivity Operating Rules

Connectivity is essential for successful interoperability as it enables the transport of information to support data exchange. To address the industry’s need to align on a common set of communication protocols, CAQH CORE maintains a set of operating rules addressing connectivity and security of data exchange. CAQH CORE Participating Organizations are currently evaluating updates to the CAQH CORE Connectivity requirements to address existing and emerging standards and protocols to support the intersection of administrative and clinical data exchange.

Conversation with CAQH CORE Board Members

On June 23, CAQH CORE staff will host a panel discussion featuring CAQH CORE Board members centered on key industry topics, including value-based payments, interoperability, and COVID-19.

Speakers:

Dr. Sue Turney (MGMA) President and CEO, Marshfield Clinic Health System

Tim Kaja Chief Operating Officer of UnitedHealth Networks, UnitedHealthcare

Dr. Marilyn Heine (AMA) Clinical Assistant Professor of Medicine, Drexel University College of Medicine

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.