Standards & EDI
Operating Rules
Draft — pending verification
This reference entry has not yet been verified against its authoritative source (Original definitions; regulatory facts to be verified against CMS-0057-F (89 FR 8758) and X12/HL7 documentation). Do not rely on it for production configuration until this notice is removed.
In more depth
Standards define message structure; operating rules define service behavior. For prior auth, the practical questions operating rules answer are things like how fast a real-time 278 response must come back and when systems may be down — the plumbing of provider experience.