---
title: Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278
description: Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278
image: https://blog.pocp.com/hubfs/Imported_Blog_Media/Ken-Kleinberg-cir.jpg
---
[](https://www.pocp.com/)
# Accelerating client's success
# using Health IT and
# business process solutions...
[Learn More](https://www.pocp.com/the-pocp-story/)
# Simplifying
# regulatory
## compliance...
[Learn More](https://www.pocp.com/regulatory-resource-center/)
# Creating value in today's
# healthcare ecosystem...
[Learn More](https://www.pocp.com/our-client/)
- Consulting
- [Strategy & Market Intelligence](https://www.pocp.com/strategy-market-intelligence/)
- [Education & Research](https://www.pocp.com/education-research/)
- [Value-Based Care Interoperability Roadmap](https://info.pocp.com/en-us/value-based-care-interoperability-strategy-and-roadmap)
- [Multi-stakeholder Collaboratives, Program Design and Management](https://www.pocp.com/multi-stakeholder-initiatives_program-design_management)
- [EHR Training Programs](https://www.pocp.com/ehr-training-programs/)
- [Life Sciences](https://www.pocp.com/life-sciences)
- [Regulatory Resource Center](https://www.pocp.com/regulatory-resource-center)
- About Us
- [The POCP Story](https://www.pocp.com/the-pocp-story/)
- [Our Clients](https://www.pocp.com/our-client/)
- [Health & IT Vendors](https://www.pocp.com/our-client/health-it-vendors/)
- [Payers & PBMS](https://www.pocp.com/our-client/payers-pbms/)
- [Accountable Care](https://www.pocp.com/our-client/accountable-care/)
- [Health Information Exchange](https://www.pocp.com/resource-library/health-information-exchange/)
- [Our Team](https://www.pocp.com/our-team/)
- [Government Contracting](https://info.pocp.com/gsa)
- [Press](https://www.pocp.com/press/)
- [Calendar](https://info.pocp.com/en-us/events)
- [Careers at POCP](https://www.pocp.com/the-pocp-story/careers-at-pocp/)
- Insights
- [Articles and Industry Comments](https://www.pocp.com/articles/)
- [Blog](https://blog.pocp.com/blog/)
- [Newsletters HIT Perspectives](https://www.pocp.com/insight/newsletters-2/)
- [Newsletters Biopharma](https://www.pocp.com/newsletters-biopharma/)
- [POCP Industry Reports](https://www.pocp.com/industry-reports)
- [POCP Industry Reports](https://www.pocp.com/industry-reports)
- [ePrior Authorization’s Real Benefits: Reducing Frictional Costs and Speeding Time to Therapy](https://www.pocp.com/downloads/ePAReport)
- [Real-Time Pharmacy Benefit Check Report](https://www.pocp.com/pocp-industry-reports/real-time-pharmacy-benefit-check-report/)
- [Fighting the Opioid Epidemic at the State- and Rx-Level Report](https://www.pocp.com/downloads/fighting-opioid-epidemic-at-rx-level-report)
- [ePrescribing State Law On-Demand](https://www.pocp.com/downloads/eprescribing-state-law-on-demand/)
- [State Law Review](https://www.pocp.com/statelawreview/)
- [Navigator](https://www.pocp.com/navigator/)
- [Podcasts](https://info.pocp.com/en-us/the-dish-on-health-it-podcast)
- [Presentations and Webinars](https://www.pocp.com/presentations/)
- [Resource Library](https://www.pocp.com/resource-library/)
- [White Papers, Webinars and Case Studies](https://www.pocp.com/white-papers-webinars-and-case-studies-2/)
- [Our video channel](https://www.pocp.com/our-video-channel)
- [Contact](https://www.pocp.com/contact/)
- Consulting
- [Strategy & Market Intelligence](https://www.pocp.com/strategy-market-intelligence/)
- [Education & Research](https://www.pocp.com/education-research/)
- [Value-Based Care Interoperability Roadmap](https://info.pocp.com/en-us/value-based-care-interoperability-strategy-and-roadmap)
- [Multi-stakeholder Collaboratives, Program Design and Management](https://www.pocp.com/multi-stakeholder-initiatives_program-design_management)
- [EHR Training Programs](https://www.pocp.com/ehr-training-programs/)
- [Life Sciences](https://www.pocp.com/life-sciences)
- [Regulatory Resource Center](https://www.pocp.com/regulatory-resource-center)
- About Us
- [The POCP Story](https://www.pocp.com/the-pocp-story/)
- [Our Clients](https://www.pocp.com/our-client/)
- [Health & IT Vendors](https://www.pocp.com/our-client/health-it-vendors/)
- [Payers & PBMS](https://www.pocp.com/our-client/payers-pbms/)
- [Accountable Care](https://www.pocp.com/our-client/accountable-care/)
- [Health Information Exchange](https://www.pocp.com/resource-library/health-information-exchange/)
- [Our Team](https://www.pocp.com/our-team/)
- [Government Contracting](https://info.pocp.com/gsa)
- [Press](https://www.pocp.com/press/)
- [Calendar](https://info.pocp.com/en-us/events)
- [Careers at POCP](https://www.pocp.com/the-pocp-story/careers-at-pocp/)
- Insights
- [Articles and Industry Comments](https://www.pocp.com/articles/)
- [Blog](https://blog.pocp.com/blog/)
- [Newsletters HIT Perspectives](https://www.pocp.com/insight/newsletters-2/)
- [Newsletters Biopharma](https://www.pocp.com/newsletters-biopharma/)
- [POCP Industry Reports](https://www.pocp.com/industry-reports)
- [POCP Industry Reports](https://www.pocp.com/industry-reports)
- [ePrior Authorization’s Real Benefits: Reducing Frictional Costs and Speeding Time to Therapy](https://www.pocp.com/downloads/ePAReport)
- [Real-Time Pharmacy Benefit Check Report](https://www.pocp.com/pocp-industry-reports/real-time-pharmacy-benefit-check-report/)
- [Fighting the Opioid Epidemic at the State- and Rx-Level Report](https://www.pocp.com/downloads/fighting-opioid-epidemic-at-rx-level-report)
- [ePrescribing State Law On-Demand](https://www.pocp.com/downloads/eprescribing-state-law-on-demand/)
- [State Law Review](https://www.pocp.com/statelawreview/)
- [Navigator](https://www.pocp.com/navigator/)
- [Podcasts](https://info.pocp.com/en-us/the-dish-on-health-it-podcast)
- [Presentations and Webinars](https://www.pocp.com/presentations/)
- [Resource Library](https://www.pocp.com/resource-library/)
- [White Papers, Webinars and Case Studies](https://www.pocp.com/white-papers-webinars-and-case-studies-2/)
- [Our video channel](https://www.pocp.com/our-video-channel)
- [Contact](https://www.pocp.com/contact/)
# Insights: Brief Points of View
# POCP Blog
---
## Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278
- June 11, 2019
- By [Ken Kleinberg](https://blog.pocp.com/blog/author/ken-kleinbergpocp-com)
- [0 Comment](https://blog.pocp.com/blog/caqh-phase-v-pa-operating-rules#comments-listing)
Share this story:
By [Ken Kleinberg](https://www.pocp.com/team/ken-kleinberg/), Practice Lead, Innovative Technologies
 Ken Kleinberg, Practice Lead
CAQH’s (Council for Affordable Quality Healthcare) [recently released](https://www.caqh.org/core/caqh-core-phase-v-operating-rules) their new Phase V CORE Operating Rules for prior authorization (PA) that improve on specificity needed to advance ePrior Authorization (ePA). Coming from the primary organization tasked with tracking and adoption of healthcare transactions, this is a timely release given the high attention being paid to PAs, especially considering [recent pushback](https://www.ama-assn.org/amaone/prior-authorization) from the AMA.[\[1\]](https://blog.pocp.com/blog/caqh-phase-v-pa-operating-rules#_ftn1)
As we analyzed in our [major report](https://www.pocp.com/downloads/ePAReport\)) on ePA, there are many challenges the industry is facing, with lack of comprehensive-enough standards and poor adoption by payers and providers being two of the largest. While the X12 278 HIPAA transaction for PA has been in use for many years, its adoption has been disappointing (about 12 percent as per the CAQH Index) – and largely over-shadowed by NCPDP standards for drugs under the pharmacy benefit (even without formal sanction). The 278 is also considered generally inadequate for handling complex aspects of drugs, devices, services, and procedures under the medical benefit. CAQH is aware of this and is doing its part to solidifying its core functions in parallel and conjunction with the development of new and complementary approaches from others in such areas as attachments, APIs and use cases. Let’s examine this.
To review, although the 278 is the federally mandated HIPAA standard for PA for providers and payers, it does not allow for attachments that include the clinical detail often required for resolution. Therefore, use of other transactions, or out-of-transaction exchange of details must occur. In addition, many EHR vendors don’t support the 278 from within clinician workflow (or may charge a premium for it), and many payer’s portals (or those of their agents or intermediaries) don’t accept it or make variable, or poor use of it. The result: about half the PA requests by providers for medical benefit are submitted manually, usually via phone and fax, in spite of long hold times and delays (ironically, often providing more clarity than limited transactions). This contrasts with several more back-office focused HIPAA transactions routinely used effectively for eligibility and benefits verification, claims and claims status, claim payment and remittance, etc., where CAQH reports adoption at 48-96 percent.
A major driver for CAQH action is to address concerns and recommendations by the National Committee on Vital and Health Statistics (NCVHS), advisors to the Secretary of Health and Human Services (HHS), as to why 278 adoption has stalled and its need to keep up with the needs of value-based payment models. CAQH also conducts its own surveys, results of which show a need to focus on data content and workflow, along with format, transport, and utilities. Providers, in particular, complain that receiving a pending status back does little to help them understand if there is more information to send, how much longer they will need to wait, or format of payer response (e.g., letter, portal notification, or phone).
For these Phase V rules, CAQH analyzed input from 100 entities comprised of providers, health plans, vendors, and the government to identify 20 levels of improvement to advance the 278 as a direct transaction from provider workflow to payer, and through web portals (about 1/3 of PA requests go this route, though it requires logging into different systems and rekeying). This progress is encouraging, although there is still much to be done, such as issues around stakeholder wait time for a response or required special handling of emergency/urgent requests.
Most notably, these new rules did not focus on attachment standards, which CAQH noted as being addressed by pending federal regulations and would therefore be handled with future CAQH rules. CAQH also considers retail pharmacy ePA and the pharmacy benefit as the purview of NCPDP. As discussed in our [ePA report](https://www.pocp.com/downloads/ePAReport), a converged set of standards for pharmacy and medical benefit is really where the industry needs to head (some of the acquisitions we’re seeing with payers and PBMs are indicative of this).
Where CAQH has focused, there is much benefit to be gained – specifically with core capabilities that any more comprehensive and transformational solution will still need to rely on. The advances were described in two rule sets with the Data Content Rule focused mainly on closing gaps of missing or incorrect information regarding medical necessity checking, and the web portal rule addressing the better mapping of data collected from a portal to adherence with the PA transaction. Improvements included:
### **278 Request / Response Data Content Rule**
- Better patient identifying and verification information to reduce common errors and associated denials, including name normalization (e.g., removal of character strings such as Jr, PHD, ESQ), punctuation, dates, and special characters processing as dependent on the various loops and segments
- More specific AAA error and action codes and related code descriptions to reduce burden of interpretation and resolving pending submissions through more specifics as to what is wrong (e.g., out of network provider) or what is required – e.g., LOINC (Logical Observation Identifier and Codes), PWK01 Attachment Report Type Codes, and Health Care Service Decision Reasons Codes (HCSDRC)
### **Prior Authorization Web Portal Rule**
- Better uniformity in data field labels (e.g., Technical Report Type 3 \[TR3\] implementation names and alias names)
- System availability to receive requests to improve predictability of response (no less than 86 percent availability per calendar week – or max of 24 hours of regularly scheduled downtime, with a week of advance notice)
- Confirmation of receipt from a web submission (with next steps)
For these latest improvements in operating rules to have the highest benefit on PA adoption, they need to be supplemented with advances in other key areas. This includes addressing the major burden for providers of not knowing if a PA is required or not, and in the difficult process of obtaining and transferring the necessary evidence to payers in a form they can readily review. For payers, it requires communicating the most up-to-date guidelines, rules, and formularies to providers, and then processing all the unstructured information often received from providers to arrive at a decision. CAQH is right that federal standards for exchanging clinical content are needed to reduce the variability inherent in the process today. Open API standards such as FHIR (Fast Healthcare Interoperability Resource) and initiatives like Da Vinci are advancing a number of use cases that will make a major difference. It’s comforting in reviewing these new rules to know that advances are being made in the core and underlying transactions and in minimum rules and requirements to reduce the infuriating challenges of communicating status and requests in such a key area as PA.
[\[1\]](https://blog.pocp.com/blog/caqh-phase-v-pa-operating-rules#_ftnref1) [https://www.ama-assn.org/practice-management/sustainability/1-4-doctors-say-prior-authorization-has-led-serious-adverse](https://www.ama-assn.org/practice-management/sustainability/1-4-doctors-say-prior-authorization-has-led-serious-adverse)
### **Related Resources:**
#### ePrior Authorization’s Real Benefits: Reducing Frictional Costs and Speeding Time to Therapy
Point-of-Care Partners leveraged our **unique perspective and relationships in the market **with payers, providers, life sciences companies, and the stakeholders supporting them to create this new and comprehensive report. Our experts brought their extensive experience with ePA, ePrescribing, medication management, and transactions in support of value-based care together with industry interviews, in the writing of this report designed to bring your team up to speed on the ePA landscape with an in-depth analysis of what the future may hold.
[Download the Report Preview](https://www.pocp.com/wp-content/uploads/ePA_-Real_-Benefits_-Report-Preview.pdf)
[Purchase the Report](https://www.pocp.com/downloads/ePAReport)
[Watch the Webinar Recording](https://register.gotowebinar.com/recording/6518281361597191691)
**[Enhancing ePrior Authorization – Is Multi-Stakeholder Win-Win Possible](https://www.pocp.com/wp-content/uploads/CBI-ePA-Philly-May-2019-POCP-Kleinberg-Final.pdf)?**
Ken Kleinberg, May 14, 2019. CBI Real-Time Benefit Check & ePrior Authorization Summit
- Post Categories
- [electronic prior authorization](https://blog.pocp.com/blog/tag/electronic-prior-authorization)
- [CAQH Phase V Operating Rules](https://blog.pocp.com/blog/tag/caqh-phase-v-operating-rules)
- [ePrior Authorization](https://blog.pocp.com/blog/tag/eprior-authorization)
# POCP Blog
---
Search
- There are no suggestions because the search field is empty.
### RECENT POSTS
### CATEGORIES
- [Interoperability (39)](https://blog.pocp.com/blog/tag/interoperability)
- [Health IT Policy (38)](https://blog.pocp.com/blog/tag/health-it-policy)
- [CMS (28)](https://blog.pocp.com/blog/tag/cms)
- [EHR (24)](https://blog.pocp.com/blog/tag/ehr)
- [FHIR (24)](https://blog.pocp.com/blog/tag/fhir)
- [Health IT Trends (20)](https://blog.pocp.com/blog/tag/health-it-trends)
- [ePrescribing (19)](https://blog.pocp.com/blog/tag/eprescribing)
- [Prior Authorization (16)](https://blog.pocp.com/blog/tag/prior-authorization)
- [Real-Time Benefit Check (15)](https://blog.pocp.com/blog/tag/real-time-benefit-check)
- [Real-Time Pharmacy Benefit Check (15)](https://blog.pocp.com/blog/tag/real-time-pharmacy-benefit-check)
- [Regulatory Trends (15)](https://blog.pocp.com/blog/tag/regulatory-trends)
- [APIs (13)](https://blog.pocp.com/blog/tag/apis)
- [Artificial Intelligence (12)](https://blog.pocp.com/blog/tag/artificial-intelligence)
- [electronic prior authorization (12)](https://blog.pocp.com/blog/tag/electronic-prior-authorization)
- [health IT (12)](https://blog.pocp.com/blog/tag/health-it)
- [Life Sciences (10)](https://blog.pocp.com/blog/tag/life-sciences)
- [NCPDP (10)](https://blog.pocp.com/blog/tag/ncpdp)
- [Policy (10)](https://blog.pocp.com/blog/tag/policy)
- [electronic health records (9)](https://blog.pocp.com/blog/tag/electronic-health-records)
- [pharmacy interoperability (9)](https://blog.pocp.com/blog/tag/pharmacy-interoperability)
- [ASTP (8)](https://blog.pocp.com/blog/tag/astp)
- [CMS NPRM (8)](https://blog.pocp.com/blog/tag/cms-nprm)
- [health information exchange (8)](https://blog.pocp.com/blog/tag/health-information-exchange)
- [HL7 (7)](https://blog.pocp.com/blog/tag/hl7)
- [Payer (7)](https://blog.pocp.com/blog/tag/payer)
- [Specialty Pharmacy (7)](https://blog.pocp.com/blog/tag/specialty-pharmacy)
- [Standards Development (7)](https://blog.pocp.com/blog/tag/standards-development)
- [TEFCA (7)](https://blog.pocp.com/blog/tag/tefca)
- [Value-Based Care (7)](https://blog.pocp.com/blog/tag/value-based-care)
- [e-Prescribing (7)](https://blog.pocp.com/blog/tag/e-prescribing)
- [electronic prescribing (7)](https://blog.pocp.com/blog/tag/electronic-prescribing)
- [Da Vinci Project (6)](https://blog.pocp.com/blog/tag/da-vinci-project)
- [HTI-2 (6)](https://blog.pocp.com/blog/tag/hti-2)
- [ONC (6)](https://blog.pocp.com/blog/tag/onc)
- [Strategy and Research (6)](https://blog.pocp.com/blog/tag/strategy-and-research)
- [healthcare reform (6)](https://blog.pocp.com/blog/tag/healthcare-reform)
- [21st Century Cures Act (5)](https://blog.pocp.com/blog/tag/21st-century-cures-act)
- [Consent (5)](https://blog.pocp.com/blog/tag/consent)
- [EPCS (5)](https://blog.pocp.com/blog/tag/epcs)
- [Federal Healthcare Policy (5)](https://blog.pocp.com/blog/tag/federal-healthcare-policy)
- [HHS (5)](https://blog.pocp.com/blog/tag/hhs)
- [Information Blocking (5)](https://blog.pocp.com/blog/tag/information-blocking)
- [NCPDP SCRIPT (5)](https://blog.pocp.com/blog/tag/ncpdp-script)
- [Patient Data (5)](https://blog.pocp.com/blog/tag/patient-data)
- [Payer Interoperability (5)](https://blog.pocp.com/blog/tag/payer-interoperability)
- [Pharmacy (5)](https://blog.pocp.com/blog/tag/pharmacy)
- [health equity (5)](https://blog.pocp.com/blog/tag/health-equity)
- [pharmaceutical marketing (5)](https://blog.pocp.com/blog/tag/pharmaceutical-marketing)
- [population health (5)](https://blog.pocp.com/blog/tag/population-health)
- [Clinical Decision Support (4)](https://blog.pocp.com/blog/tag/cds)
- [Digital Health Programs (4)](https://blog.pocp.com/blog/tag/digital-health-programs)
- [Digital Therapeutics (4)](https://blog.pocp.com/blog/tag/digital-therapeutics)
- [EHR Dashboard (4)](https://blog.pocp.com/blog/tag/ehr-dashboard)
- [EHR Usability (4)](https://blog.pocp.com/blog/tag/ehr-usability)
- [HIE (4)](https://blog.pocp.com/blog/tag/hie)
- [Health Plans (4)](https://blog.pocp.com/blog/tag/health-plans)
- [Health Technology Solutions (4)](https://blog.pocp.com/blog/tag/health-technology-solutions)
- [Meaningful Use (4)](https://blog.pocp.com/blog/tag/meaningful-use)
- [PDMP (4)](https://blog.pocp.com/blog/tag/pdmp)
- [Pharmacy Benefit Management (4)](https://blog.pocp.com/blog/tag/pharmacy-benefit-management)
- [Strategic roadmap (4)](https://blog.pocp.com/blog/tag/strategic-roadmap)
- [burden reduction (4)](https://blog.pocp.com/blog/tag/burden-reduction)
- [ePrior Authorization (4)](https://blog.pocp.com/blog/tag/eprior-authorization)
- [healthcare regulations (4)](https://blog.pocp.com/blog/tag/healthcare-regulations)
- [pharmacy advance practice (4)](https://blog.pocp.com/blog/tag/pharmacy-advance-practice)
- [price transparency (4)](https://blog.pocp.com/blog/tag/price-transparency)
- [COVID-19 (3)](https://blog.pocp.com/blog/tag/covid-19)
- [Clinical Calculators (3)](https://blog.pocp.com/blog/tag/clinical-calculators)
- [Data Governance (3)](https://blog.pocp.com/blog/tag/data-governance)
- [Diabetes Care (3)](https://blog.pocp.com/blog/tag/diabetes-care)
- [Digital Health (3)](https://blog.pocp.com/blog/tag/digital-health)
- [Drug price transparency (3)](https://blog.pocp.com/blog/tag/drug-price-transparency)
- [EHR Reports (3)](https://blog.pocp.com/blog/tag/ehr-reports)
- [HIMSS (3)](https://blog.pocp.com/blog/tag/himss)
- [Healthcare AI (3)](https://blog.pocp.com/blog/tag/healthcare-ai)
- [Implementation (3)](https://blog.pocp.com/blog/tag/implementation)
- [Innovation (3)](https://blog.pocp.com/blog/tag/innovation)
- [Medication Therapy Management (3)](https://blog.pocp.com/blog/tag/mtm)
- [National Patient Identifier (3)](https://blog.pocp.com/blog/tag/national-patient-identifier)
- [Patient Safety (3)](https://blog.pocp.com/blog/tag/patient-safety)
- [Pharmacy Benefit (3)](https://blog.pocp.com/blog/tag/pharmacy-benefit)
- [Request for Information (3)](https://blog.pocp.com/blog/tag/request-for-information)
- [Speed to Therapy (3)](https://blog.pocp.com/blog/tag/speed-to-therapy)
- [state prescribing laws (3)](https://blog.pocp.com/blog/tag/state-prescribing-laws)
- [Administrative Burden (2)](https://blog.pocp.com/blog/tag/administrative-burden)
- [CDC (2)](https://blog.pocp.com/blog/tag/cdc)
- [Centers for Disease Control (2)](https://blog.pocp.com/blog/tag/centers-for-disease-control)
- [Controlled Substances (2)](https://blog.pocp.com/blog/tag/controlled-substances)
- [Data Efficiency (2)](https://blog.pocp.com/blog/tag/data-efficiency)
- [EHR Certification (2)](https://blog.pocp.com/blog/tag/ehr-certification)
- [EHR Guides (2)](https://blog.pocp.com/blog/tag/ehr-guides)
- [EHRs (2)](https://blog.pocp.com/blog/tag/ehrs)
- [Epic (2)](https://blog.pocp.com/blog/tag/epic)
- [Formulary and Benefit (2)](https://blog.pocp.com/blog/tag/formulary-and-benefit)
- [H.R. 6 (2)](https://blog.pocp.com/blog/tag/h-r-6)
- [Market Assessment (2)](https://blog.pocp.com/blog/tag/market-assessment)
- [Medical Benefit (2)](https://blog.pocp.com/blog/tag/medical-benefit)
- [Medical Pharmacy Benefit Integration (2)](https://blog.pocp.com/blog/tag/medical-pharmacy-benefit-integration)
- [Medicare Payment Reform (2)](https://blog.pocp.com/blog/tag/medicare-payment-reform)
- [Medication Adherence (2)](https://blog.pocp.com/blog/tag/medication-adherence)
- [Member Data (2)](https://blog.pocp.com/blog/tag/member-data)
- [NCPDP Telecommunications Standard Version F6 (2)](https://blog.pocp.com/blog/tag/ncpdp-telecommunications-standard-version-f6)
- [ONC Physician Burden Reduction (2)](https://blog.pocp.com/blog/tag/onc-physician-burden-reduction)
- [Opioid prescribing laws (2)](https://blog.pocp.com/blog/tag/opioid-prescribing-laws)
- [PGx (2)](https://blog.pocp.com/blog/tag/pgx)
- [Part D (2)](https://blog.pocp.com/blog/tag/part-d)
- [Patient Record Sharing (2)](https://blog.pocp.com/blog/tag/patient-record-sharing)
- [Pharmaceutical Manufacturers (2)](https://blog.pocp.com/blog/tag/pharmaceutical-manufacturers)
- [Policy monitoring (2)](https://blog.pocp.com/blog/tag/policy-monitoring)
- [Pre-approval Information Exchange (2)](https://blog.pocp.com/blog/tag/pre-approval-information-exchange)
- [Precision Medicine (2)](https://blog.pocp.com/blog/tag/precision-medicine)
- [REMS (2)](https://blog.pocp.com/blog/tag/rems)
- [Regulatory landscape (2)](https://blog.pocp.com/blog/tag/regulatory-landscape)
- [Specialty Pharmacy Automation (2)](https://blog.pocp.com/blog/tag/specialty-pharmacy-automation)
- [Specialty ePrescribing (2)](https://blog.pocp.com/blog/tag/specialty-eprescribing)
- [Speed to Medication Therapy (2)](https://blog.pocp.com/blog/tag/speed-to-medication-therapy)
- [Telehealth (2)](https://blog.pocp.com/blog/tag/telehealth)
- [Telemedicine (2)](https://blog.pocp.com/blog/tag/telemedicine)
- [care coordination (2)](https://blog.pocp.com/blog/tag/care-coordination)
- [compliance (2)](https://blog.pocp.com/blog/tag/compliance)
- [ePA (2)](https://blog.pocp.com/blog/tag/epa)
- [eRx (2)](https://blog.pocp.com/blog/tag/erx)
- [health dashboards (2)](https://blog.pocp.com/blog/tag/health-dashboards)
- [medication management (2)](https://blog.pocp.com/blog/tag/medication-management)
- [opioid abuse (2)](https://blog.pocp.com/blog/tag/opioid-abuse)
- [patient access (2)](https://blog.pocp.com/blog/tag/patient-access)
- [pharmacist (2)](https://blog.pocp.com/blog/tag/pharmacist)
- [pharmacy business model (2)](https://blog.pocp.com/blog/tag/pharmacy-business-model)
- [prior authorizations (2)](https://blog.pocp.com/blog/tag/prior-authorizations)
- [wearables (2)](https://blog.pocp.com/blog/tag/wearables)
- [ACO (1)](https://blog.pocp.com/blog/tag/aco)
- [AI Policy (1)](https://blog.pocp.com/blog/tag/ai-policy)
- [Antikickback Statutes Reform (1)](https://blog.pocp.com/blog/tag/antikickback-statutes-reform)
- [Biologics and Biosimilars Naming (1)](https://blog.pocp.com/blog/tag/biologics-and-biosimilars-naming)
- [Biosimilars (1)](https://blog.pocp.com/blog/tag/biosimilars)
- [Business Process (1)](https://blog.pocp.com/blog/tag/business-process)
- [CAQH Phase V Operating Rules (1)](https://blog.pocp.com/blog/tag/caqh-phase-v-operating-rules)
- [CARIN Alliance (1)](https://blog.pocp.com/blog/tag/carin-alliance)
- [CDS Hooks (1)](https://blog.pocp.com/blog/tag/cds-hooks)
- [CMS Attachments Rule (1)](https://blog.pocp.com/blog/tag/cms-attachments-rule)
- [CMS-0062P (1)](https://blog.pocp.com/blog/tag/cms-0062p)
- [CRD (1)](https://blog.pocp.com/blog/tag/crd)
- [Canada Biosimilars Naming (1)](https://blog.pocp.com/blog/tag/canada-biosimilars-naming)
- [Canadian ePrescribing (1)](https://blog.pocp.com/blog/tag/canadian-eprescribing)
- [Chronic Disease (1)](https://blog.pocp.com/blog/tag/chronic-disease)
- [Clinical Quality Language (CQL) (1)](https://blog.pocp.com/blog/tag/clinical-quality-language-cql)
- [CodeX (1)](https://blog.pocp.com/blog/tag/codex)
- [CoverMyMeds (1)](https://blog.pocp.com/blog/tag/covermymeds)
- [DSMO (1)](https://blog.pocp.com/blog/tag/dsmo)
- [DTR (1)](https://blog.pocp.com/blog/tag/dtr)
- [DTx (1)](https://blog.pocp.com/blog/tag/dtx)
- [Data Modernization Initiative (1)](https://blog.pocp.com/blog/tag/data-modernization-initiative)
- [Data quality (1)](https://blog.pocp.com/blog/tag/data-quality)
- [Designated Standards Maintenance Organizations (1)](https://blog.pocp.com/blog/tag/designated-standards-maintenance-organizations)
- [Digital Therapeutics Opportunities (1)](https://blog.pocp.com/blog/tag/digital-therapeutics-opportunities)
- [Digital Therapeutics Outlook (1)](https://blog.pocp.com/blog/tag/digital-therapeutics-outlook)
- [Discover Alliance (1)](https://blog.pocp.com/blog/tag/discover-alliance)
- [Drug Launch (1)](https://blog.pocp.com/blog/tag/drug-launch)
- [Drug Manufacturers (1)](https://blog.pocp.com/blog/tag/drug-manufacturers)
- [Drug PA (1)](https://blog.pocp.com/blog/tag/drug-pa)
- [Drug abuse (1)](https://blog.pocp.com/blog/tag/drug-abuse)
- [EHR Apps (1)](https://blog.pocp.com/blog/tag/ehr-apps)
- [Enforcement (1)](https://blog.pocp.com/blog/tag/enforcement)
- [FDA (1)](https://blog.pocp.com/blog/tag/fda)
- [FQHC (1)](https://blog.pocp.com/blog/tag/fqhc)
- [Federally Qualified Health Centers (1)](https://blog.pocp.com/blog/tag/federally-qualified-health-centers)
- [Fee-for-service (1)](https://blog.pocp.com/blog/tag/fee-for-service)
- [Gold-carding (1)](https://blog.pocp.com/blog/tag/gold-carding)
- [HIN (1)](https://blog.pocp.com/blog/tag/hin)
- [HIPAA (1)](https://blog.pocp.com/blog/tag/hipaa)
- [HIT Leaders (1)](https://blog.pocp.com/blog/tag/hit-leaders)
- [HTI-4 (1)](https://blog.pocp.com/blog/tag/hti-4)
- [Health and Human Services (1)](https://blog.pocp.com/blog/tag/health-and-human-services)
- [Health data (1)](https://blog.pocp.com/blog/tag/health-data)
- [Health system (1)](https://blog.pocp.com/blog/tag/health-system)
- [Healthcare artificial intelligence trends (1)](https://blog.pocp.com/blog/tag/healthcare-artificial-intelligence-trends)
- [Human Services (1)](https://blog.pocp.com/blog/tag/human-services)
- [Hypertension (1)](https://blog.pocp.com/blog/tag/hypertension)
- [I-STOP (1)](https://blog.pocp.com/blog/tag/i-stop)
- [Insurance (1)](https://blog.pocp.com/blog/tag/insurance)
- [Landscape analysis (1)](https://blog.pocp.com/blog/tag/landscape-analysis)
- [MACRA (1)](https://blog.pocp.com/blog/tag/macra)
- [MIPS (1)](https://blog.pocp.com/blog/tag/mips)
- [Market Intelligence (1)](https://blog.pocp.com/blog/tag/market-intelligence)
- [Market Research (1)](https://blog.pocp.com/blog/tag/market-research)
- [Medication Therapy Management (1)](https://blog.pocp.com/blog/tag/medication-therapy-management)
- [Modernizing Part D CMS-4180-P (1)](https://blog.pocp.com/blog/tag/modernizing-part-d-cms-4180-p)
- [NCPDP F&B (1)](https://blog.pocp.com/blog/tag/ncpdp-fb)
- [NCPDP SCRIPT 2017071 (1)](https://blog.pocp.com/blog/tag/ncpdp-script-2017071)
- [NCPDP Workgroups (1)](https://blog.pocp.com/blog/tag/ncpdp-workgroups)
- [NCQA (1)](https://blog.pocp.com/blog/tag/ncqa)
- [NPI (1)](https://blog.pocp.com/blog/tag/npi)
- [Objective Analysis (1)](https://blog.pocp.com/blog/tag/objective-analysis)
- [Outcomes (1)](https://blog.pocp.com/blog/tag/outcomes)
- [P2 FHIR Taskforce (1)](https://blog.pocp.com/blog/tag/p2-fhir-taskforce)
- [PAS (1)](https://blog.pocp.com/blog/tag/pas)
- [PBMs (1)](https://blog.pocp.com/blog/tag/pbms)
- [PIE (1)](https://blog.pocp.com/blog/tag/pie)
- [POCP News (1)](https://blog.pocp.com/blog/tag/pocp-news)
- [Pain Management (1)](https://blog.pocp.com/blog/tag/pain-management)
- [Pharmacogenomics (1)](https://blog.pocp.com/blog/tag/pharmacogenomics)
- [Population Health Management (1)](https://blog.pocp.com/blog/tag/population-health-management)
- [Prescribing Authority (1)](https://blog.pocp.com/blog/tag/prescribing-authority)
- [Prescribing signatures (1)](https://blog.pocp.com/blog/tag/prescribing-signatures)
- [Prescription Price Transparency (1)](https://blog.pocp.com/blog/tag/prescription-price-transparency)
- [Prescription affordability (1)](https://blog.pocp.com/blog/tag/prescription-affordability)
- [Prescription drug benefit (1)](https://blog.pocp.com/blog/tag/prescription-drug-benefit)
- [Prescription pricing (1)](https://blog.pocp.com/blog/tag/prescription-pricing)
- [Public Health (1)](https://blog.pocp.com/blog/tag/public-health)
- [Quality Measures (1)](https://blog.pocp.com/blog/tag/quality-measures)
- [Quality Reporting (1)](https://blog.pocp.com/blog/tag/quality-reporting)
- [RTBT (1)](https://blog.pocp.com/blog/tag/rtbt)
- [RTPB (1)](https://blog.pocp.com/blog/tag/rtpb)
- [Regulatory overhead (1)](https://blog.pocp.com/blog/tag/regulatory-overhead)
- [RelayHealth (1)](https://blog.pocp.com/blog/tag/relayhealth)
- [Rx renewal (1)](https://blog.pocp.com/blog/tag/rx-renewal)
- [RxBC (1)](https://blog.pocp.com/blog/tag/rxbc)
- [Sandbox (1)](https://blog.pocp.com/blog/tag/sandbox)
- [Social Determinants of Health (1)](https://blog.pocp.com/blog/tag/social-determinants-of-health)
- [Specialty Pharmacy Enrollment (1)](https://blog.pocp.com/blog/tag/specialty-pharmacy-enrollment)
- [Specialty medication (1)](https://blog.pocp.com/blog/tag/specialty-medication)
- [Stark Anti-Kickback Statute (1)](https://blog.pocp.com/blog/tag/stark-anti-kickback-statute)
- [Stark Law Reform (1)](https://blog.pocp.com/blog/tag/stark-law-reform)
- [State policy (1)](https://blog.pocp.com/blog/tag/state-policy)
- [Surescripts (1)](https://blog.pocp.com/blog/tag/surescripts)
- [Telecommunications (1)](https://blog.pocp.com/blog/tag/telecommunications)
- [Telehealth / Telemedicine (1)](https://blog.pocp.com/blog/tag/telehealth-telemedicine)
- [U.S. Senate Special Committee on Aging (1)](https://blog.pocp.com/blog/tag/u-s-senate-special-committee-on-aging)
- [Uncategorized (1)](https://blog.pocp.com/blog/tag/uncategorized)
- [Virtual Visits (1)](https://blog.pocp.com/blog/tag/virtual-visits)
- [Working from home (1)](https://blog.pocp.com/blog/tag/working-from-home)
- [X12 (1)](https://blog.pocp.com/blog/tag/x12)
- [blockchain (1)](https://blog.pocp.com/blog/tag/blockchain)
- [care gaps (1)](https://blog.pocp.com/blog/tag/care-gaps)
- [community pharmacy (1)](https://blog.pocp.com/blog/tag/community-pharmacy)
- [consumerism (1)](https://blog.pocp.com/blog/tag/consumerism)
- [data platforms (1)](https://blog.pocp.com/blog/tag/data-platforms)
- [digiceuticals (1)](https://blog.pocp.com/blog/tag/digiceuticals)
- [digital health platforms (1)](https://blog.pocp.com/blog/tag/digital-health-platforms)
- [eConsent (1)](https://blog.pocp.com/blog/tag/econsent)
- [eMedication Management (1)](https://blog.pocp.com/blog/tag/emedication-management)
- [healthcare (1)](https://blog.pocp.com/blog/tag/healthcare)
- [home health (1)](https://blog.pocp.com/blog/tag/home-health)
- [machine learning (1)](https://blog.pocp.com/blog/tag/machine-learning)
- [medical deserts (1)](https://blog.pocp.com/blog/tag/medical-deserts)
- [patient generated data (1)](https://blog.pocp.com/blog/tag/patient-generated-data)
- [payers (1)](https://blog.pocp.com/blog/tag/payers)
- [payment model (1)](https://blog.pocp.com/blog/tag/payment-model)
- [prescription drug monitoring programs (1)](https://blog.pocp.com/blog/tag/prescription-drug-monitoring-programs)
- [rural health (1)](https://blog.pocp.com/blog/tag/rural-health)
- [vive (1)](https://blog.pocp.com/blog/tag/vive)
See all
[](https://www.pocp.com)
©2026 Point-of-Care Partners | All Rights Reserved
- [](https://twitter.com/pocpHIT)
- [](http://www.linkedin.com/company/point-of-care-partners)
- [](https://www.pocp.com/pocp-blog/)
```json
{
"@context" : "https://schema.org",
"@type" : "BlogPosting",
"author" : {
"@type" : "Person",
"name" : "Ken Kleinberg",
"url" : "https://blog.pocp.com/blog/author/ken-kleinbergpocp-com"
},
"dateModified" : "2020-07-11T18:08:56.633Z",
"datePublished" : "2019-06-11T14:32:06.000Z",
"headline" : "Well-Intentioned CAQH Releases PA Operating Rules for Disappointing X12 278",
"image" : [ "https://blog.pocp.com/hubfs/Imported_Blog_Media/Ken-Kleinberg-cir.jpg" ],
"mainEntityOfPage" : {
"@id" : "https://blog.pocp.com/blog/caqh-phase-v-pa-operating-rules",
"@type" : "WebPage"
},
"publisher" : {
"@type" : "Organization",
"logo" : {
"@type" : "ImageObject",
"url" : "https://blog.pocp.com/hubfs/pocp-logo-2016.jpg"
},
"name" : "Point-of-Care Partners"
}
}
```