RevCycle Intelligence May 17, 2019
Jacqueline LaPointe

Phase V operating rules from CAQH CORE aim to increase prior authorization automation by standardizing data and web portal use.

CAQH’s Committee on Operating Rules for Information Exchange (CORE) recently released Phase V operating rules to move the healthcare industry toward full prior authorization automation.

The new operating rules are the result of a collaborative multi-stakeholder effort to address the burdensome prior authorization process. Approved by nearly 90 percent of voting CAQH CORE participating organizations, including providers and health plans, the rules specifically address prior authorization data content and web portal use.

“Not only do the operating rules announced today represent a foundational step forward in improving the prior authorization process,” Tim Kaja, COO of UnitedHealth Networks and CAQH CORE board vice...

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