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:

CCHP Unveils Telehealth Reimbursement Guide for Providers

The Center for Connected Health Policy has unveiled a telehealth billing guide, aimed at helping healthcare providers navigate the confusing waters of connected health reimbursement. With roughly three-quarters of the nation’s hospitals and health systems now using telemedicine or mHealth technology, “it is not surprising then that the question of billing is the foremost question heard by telehealth resource centers, followed by ‘will I get paid?’” CCHP officials point out in their 21-page resource guide. And because reimbursement isn’t guaranteed for any specific service, it’s on the provider to navigate a path to payment. Telehealth reimbursement consistently ranks as one the largest barriers to adoption, thanks in part to restrictions placed on Medicare coverage by the Centers for Medicare & Medicaid Services, different protocols for Medicaid coverage in each state and varying policies among private payers. The CCHP guide focuses primarily on fee-for-service Medicare rules and Medicaid policies, as seen in California’s Medi-Cal program.