Existing Wording: U.S. regulations mandate that X12 be used for communicating prior authorization requests and responses. However, few electronic health record (EHR) systems have implemented this interface.

Proposed Wording: The Administrative Simplification provisions of HIPAA mandate that the X12 278 Health Care Services Review Request for Review and Response be used for communicating prior authorization requests and responses.

Comment:

For clarity sake, the guide should specifically state the controlling regulation and the particular guide that is currently mandated

Summary:

For clarity sake, the guide should specifically state the controlling regulation and the particular guide that is currently mandated