Are providers required to send an unsolicited X12 275 transaction when sending the original X12 278 request?

No. Providers are not required to send an unsolicited X12 275 to support an X12 278 prior authorization request or X12 837 claim submission. The requirements only apply in instances when the provider sends an unsolicited X12 275, but they are not required to do so.

Will the CAQH CORE Attachments Prior Authorization Infrastructure Rule require providers to use the X12 275 transaction to send attachments to support a prior authorization request?

No. Providers are not required to use non-HIPAA mandated transactions, including the X12 v6020X316 275 transaction, to send an attachment or additional documentation. If providers do choose to use X12 275 to send an attachment, they should follow the relevant operating rule requirements.

Why was the X12 v5010 chosen for Prior Authorization Transactions when the rule supports v6020 of the Attachments transaction?

Since v5010X217 278 is currently specified in the CAQH CORE Prior Authorization Operating Rules and is the HIPAA-mandated version, the Attachments Subgroup – Prior Authorization Use Case voted, using a consensus-driven approach including straw polls, feedba

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