Comment

Updates to CORE PA and Referrals Page

CORE recommends several substantive content and clarifying changes to the CAQH CORE Operating Rules for Prior Authorization and Referrals website. The changes are outlined on Page 6-7 of the letter found at this link: CORE Submission for the 2024 ISA Open Comment Period.

Pharmacy HIT Collaborative (PHIT) comment

PHIT supports NCPDP’s recommendation of adding NCPDP SCRIPT Standard, Implementation Guide, Version 2022011 to the implementation specification.

 

CAQH CORE Operating Rules for PA and Referral Updates

Changes to Operating Rules for Prior Authorization and Referrals are on pages 10-11 in the attached document. CAQH CORE proposes an update to change the name of this section from “CAQH CORE Operating Rules for Prior Authorization” to “CAQH CORE Operating Rules for Prior Authorization and Referrals.”  Other changes are primarily non-substantive and address consistency, conciseness, and grammar and syntax. Changes are highlighted in gray with proposed deletions shown as strikethrough text.

CAQH CORE ISA Letter 2022_3.pdf

NCPDP Comments

  1. Add the following:

Type-Implementation Specification

Standard Implementation/Specification- NCPDP SCRIPT Standard, Implementation Guide, Version 2017071

Standards Process Maturity – Final

Implementation Maturity- Production

Adoption Level – 5

Federally Required – No

Cost – $

Test Tool Availability – Yes

Test Tool Link: https://tools.ncpdp.org/erx/#/home

  1. NCPDP operating rules are in the NCPDP SCRIPT Standard, Implementation Guide Version 2017071

updated weblink

updated weblink

CAQH CORE Comments to ONC ISA - Phase V

Aligning ISA with New Operating Rule Structure: In Spring 2020, CAQH CORE restructured its operating rules from phase-based rule sets to rule sets based on the business processes supported by the rules. No substantive changes were made to existing rule requirements. As a result of the restructuring, CAQH CORE recommends updates to the following sections of the ISA:

Operating Rules for Prior Authorization (Phase V) -- Prior Authorization & Referrals Operating Rules

ISA Comments from CAQH CORE 11.1.20 FINAL_4.pdf