CAQH CORE Approves Two-Day Rule to Accelerate Prior Authorization Process

CAQH CORE, a multi-stakeholder organization representing a broad spectrum of health plans, providers, vendors, and government entities, has voted to set two-day time limits on how quickly health plans must request additional supporting information from providers and make final determinations on prior authorization requests. With this operating rule, CAQH CORE participating organizations agreed to update requirements in the CAQH CORE 278 Prior Authorization Infrastructure Rule. The new requirements set national expectations for prior authorization turnaround times using the HIPAA-mandated standard to move the industry toward greater automation. In particular, the updated operating rule establishes maximum timeframes at key stages in the prior authorization process for both batch and real-time transactions: