CORE-Certified Organizations/Products

View pending and current CORE Certifications below. CAQH certifies and awards CORE Certification Seals to entities that create, transmit or use the administrative transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product is operating in conformance with a specific phase(s) of the CAQH CORE Operating Rules. Voluntary CORE Certification is available for providers, health plans, clearinghouses, and product vendors.

Organizations that do not create, transmit, or use administrative healthcare transactions, and therefore cannot implement the CAQH CORE Operating Rules, can demonstrate their support for the CORE mission and vision and operating rules by applying for and using the CORE Endorser Seal. View endorser organizations by visiting the CORE Endorsers page.

Health Plans

Organization   Certified Phase(s)
(Committed Phase(s))
Aetna, Inc. Phase I
Phase II
Alabama Medicaid Agency

 
 
(Phase I & II: Q4 2014)
Anthem Colorado* Phase I
Phase II
Anthem Connecticut* Phase I
Phase II
Anthem Indiana* Phase I
Phase II
Anthem Kentucky* Phase I
Phase II
Anthem Maine* Phase I
Phase II
Anthem Nevada* Phase I
Phase II
Anthem New Hampshire* Phase I
Phase II
Anthem Ohio* Phase I
Phase II
Anthem Virginia* Phase I
Phase II
AultCare Phase I
Phase II
Phase III
AvMed Health Plans
Phase I
Phase II
Blue Cross of California* Phase I
Phase II
Blue Cross Blue Shield of Georgia* Phase I
Phase II
Blue Cross Blue Shield of Missouri* Phase I
Phase II
Blue Cross Blue Shield of Nebraska4 Phase I
Phase II
Phase III
Blue Cross Blue Shield of North Carolina
Phase I
Phase II
Phase III
BlueCross BlueShield of Tennessee Phase I
Phase II
Blue Cross Blue Shield of Wisconsin* Phase I
Phase II
Centene Corporation6 Phase I
Phase II
Phase III
Cigna
Phase I
Phase II
Empire Blue Cross Blue Shield* Phase I
Phase II
 
Excellus Health Plan

Phase I
Phase II
Phase III
 
Florida Division of Medicaid

Phase I
Phase II
Phase III
 
Harvard Pilgrim Health Care
Phase I
Phase II
HealthNet Phase I
Phase II
Horizon Blue Cross Blue Shield of New Jersey
Phase I
Phase II
(Phase III: Q4 2014)
Humana2 7 Phase I
Phase II
Phase III
Kaiser Permanente Colorado Phase I
Phase II
MaineCare
 
  (Phase I & II: Q3 2014)
MVP Health Care Phase I
Phase II
Oklahoma Employees Group Insurance Division  

(Phase I & II: Q4 2014)
 
Rocky Mountain Health Plans5
Phase I
Phase II
(Phase III: Q3 2014)
Triple-S Salud 8
BlueCross BlueShield of Puerto Rico
Phase I
Phase II
Phase III
 
Tufts Health Plan
 
Phase I
Phase II
UnitedHealth Group1 3 Phase I
Phase II
WellPoint Phase I
Phase II

Providers

Organization   Certified Phase(s)
(Committed Phase(s))
Mayo Clinic Phase I
(Phase II: Q3 2014)
Montefiore Medical Center Phase I
Phase II
Solstas Lab Partners Group, LLC Phase I
Summit Medical Group Phase I
U.S. Department of Veterans Affairs Phase I
Wake Forest University Health Sciences Phase I

Clearinghouses

Organization
Product
  Certified Phase(s)
(Committed Phase(s))
AdminisTEP, LLC
AdminisTEP Next Generation Clearinghouse including Eligibility and Claim Status
 
  (Phase I: Q4 2014)
ASSERTUS 
ASSERTUS Clearinghouse v1.9
 
  (Phase I & II: Q3 2014)
Availity, LLC
Availity Health Information Network
Phase I
Phase II
Capario
Phoenix Processing System
Phase I
Phase II
ClaimRemedi
ClaimRemedi EDI Services - Eligibility
 
Phase I
Phase II
Dorado Systems
Insurance Validator
Phase I
Phase II
 
Emdeon Inc.
Real Time Transaction Processing and Data Hosting Service
Phase I
Phase II
 
Emdeon Inc.
Remittance and Payment Management
Phase III
eServices Group Inc.
Unite
Phase I
Phase II
GE Healthcare
Centricity EDI Clearinghouse
Phase I
Phase II​
HEALTHeLink
HEALTHeNET
Phase I
Phase II
HeW
Revenue Cycle Management & EDI Services
Phase I
Phase II
Phase III
HealthFusion
HealthFusion® Real-Time
Phase I
Phase II
HMS
HMS
Phase I
InstaMed
InstaMed Network
Phase I
Phase II
Phase III
MD On-Line, Inc.
ACCE$$ Patient Eligibility Verification
Phase I
Phase II
(Phase III: Q3 2014)
NaviNet
NaviNet
Phase I
Phase II
Office Ally
Office Ally Clearinghouse
Phase I
Phase II
OptumInsight
Optum Netwerkes v2.2.0
Phase I
Phase II
OptumInsight
Optum Transaction Exchange v2.0.1 & v2.2.0
Phase I
Phase II
Passport Health Communications
OneSource
 
Phase I
Phase II
Pay Span
PaySpanHealth.com
 
Phase III
Post-N-Track
Doohickey™ Web Services
 
Phase I
Phase II
Practice Insight
EDIinsight
 
Phase I
(Phase II: Q4 2014)
RealMed Corporation
RealMed Revenue Cycle Management
 
Phase I
RelayHealth
RelayExchange™
 
Phase I
Phase II
SecureEDI/Immediata
SecureEDI Clearinghouse
 
Phase I
Siemens/HDX
Healthcare Data Exchange
 
Phase I
Phase II
Smart Data Solutions
Smart Data Stream Clearinghouse
Phase I
Phase II
 
SoftCare
ClaimsPlus v1.0.1
 
(Phase I & II: Q4 2014)
Surescripts
Surescripts Prescription Benefit
Phase I
TransUnion Healthcare, LLC
MedConnect
Phase I
The SSI Group, Inc
ClickON E-Verify Suite
Phase I
Phase II
TriZetto Provider Solutions
Integrated Eligibility & Integrated Claim Status Inquiry
Phase I
Phase II
UHIN
uTRANSEND v2.0
 

(Phase I & Phase II: Q4 2014)
 
Xerox
ACS EDI Direct
Phase I
Phase II
ZirMed
Real Time Eligibility
Phase I

Vendors

Organization
Product
  Certified Phase(s)
(Committed Phase(s))
ABILITY
Secure Exchange Software Interactive
Phase I
(Phase II: Q3 2014)
athenahealth
athenaCollector
Phase I
Phase II
 
Phase III
Automated HealthCare Solutions (AHCS)
ezVerify
 
Phase I: Q1 2015)
CSC
CSC DirectConnect®
Phase I
(Phase II: Q3 2014)
Datavi
P3NET

Phase III
ECHO Health, Inc.
National EFT/ERA Simplicity Payment Solution v8.1
Phase III
 
Eldorado, Inc.
Javelina Real-Time
 
Phase I
Phase II
EmergingHealth
TREKS
Phase I
eServices Group, Inc.
XJ Series Gateway Services
Phase I
Phase II
GE Healthcare
Centricity Business Version 4.0 and Version 4.3
Phase I
GE Healthcare
Centricity Business Version 5.0 Eligibility/Benefits
Phase I
Phase II
GE Healthcare
Centricity Business Version 5.0 Claim Status
(Phase I & II: Q3 2014)
HealthTrio, LLC
connect
Phase I
Phase II
 
ikaSystems
ikaClaims version 5.X suite
 

Phase I
Phase II
Loxogon
Loxogon Alloy™
Phase I
Medical Informatics Engineering
WebChart EMR
Phase I
Medical Present Value, Inc. (MPV)
MPV Eligibility
Phase I
 
MEDITECH
EDI Eligibility Validation - Version Client/Server 5.66

Phase I
Phase II
NextGen Healthcare
NextGen® Practice Management (Small & Group Practices)
Phase I
Phase II
NoMoreClipboard.com
NoMoreClipboard.com
Phase I
 
Orbograph
Orbograph E2Post with Reassociation
  Phase III
Pay-Plus® Solutions, Inc.
Pay-Plus Direct
Phase III
Recondo Technology
Eligibility Plus
(Phase I & II: Q3 2014)
Recondo Technology
SurePayHealth
Phase I
Phase II
RelayHealth
RelayPayer Connectivity Services (PCS)
Phase I
Phase II
Phase III
RelayHealth
RelayClearance™ Plus Version 4.6
Phase I
Phase II
The SSI Group Inc
ClickON E-Verify Suite
Phase I
Phase II
Ventanex
Provider Pay Application
  Phase III

*Indicates a WellPoint company

CORE Health Plan IT Exemptions & Out of Scope Designations:

Exemptions: The CAQH CORE Exemption Policy allows a health plan seeking voluntary CORE Certification to request that a scheduled migration of an existing IT system(s) or recent mergers at the time of CORE Certification be exempt from CAQH CORE Conformance. Health plan exemptions will be granted only if:

  • The exempted system affects no more than 30% of the health plan's membership or total electronic remittance advice plus electronic payment transactions and
  • The remainder of the health plan's IT systems is in conformance with all applicable CAQH CORE Operating Rule requirements.
  • A documented plan is in place for the exempted IT system(s) to be brought into conformance with the CAQH CORE Operating Rules.

The CAQH CORE Exemption Policy requires that within 12 months of the health plan's CORE Certification all exempt systems must be remediated to operate in conformance with the applicable CAQH CORE Operating Rules.

Out of Scope Designations: Out of Scope Designations are applied when claims are fully owned and processed by another organization and, therefore, the CAQH CORE Operating Rules cannot be applied by the certifying health plan (i.e., member data for the product is wholly owned by the external organization). If a health plan touches the administrative data but outsources some processing to a Business Associate(s), an Out of Scope Designation does not apply.

Exemptions & Out of Scope Designations for CORE-certified Health Plans

System Exemptions:

1 UnitedHealth Group (UHG): United Healthcare Community Plan, a UHG subsidiary, will be migrated to a platform that is Phase I and II CORE-certified by Q4 2013. This product covers less than 30% of UHG's membership.

7 Humana: CarePlus Health Plans, Inc., a Humana subsidiary, will be remediated to be Phase III CORE-certified by Q3 2014. This product covers less than 30% of Humana's total ERA and EFT transactions.

Out of Scope Designations:

2 Humana: Humana Military Healthcare Services (HMHS) and Humana Puerto Rico, covering approximately 30% of Humana's membership, are out of scope for the Phase I, II, and III CAQH CORE Operating Rules. HMHS claims are owned and processed by PGBA of South Carolina and, as a non-US product, Humana Puerto Rico is not covered by the CAQH CORE Operating Rules.

3 UnitedHealth Group: OptumRx (formerly Prescription Solutions, Inc.) is out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules; claims are wholly owned and processed by OptumRx.

4 Blue Cross Blue Shield of Nebraska (BCBS NE): BCBS NE's Medicare Advantage and Vision products, covering less than 10% of BCBS NE's membership, are out of scope for the CAQH CORE Operating Rules. Claims for these products are owned and processed by ClearStone Solutions (for Medicare Advantage) and VSP and Davis Vision (for Vision product).

5 Rocky Mountain Health Plans (RMHP): RMHP's non-medical Dental and Vision products, covering less than 10% of RMHP's membership, are out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules. Claims for these products are owned and processed by Delta Dental (for Dental product) and VSP (for Vision product).

6 Centene Corporation: Centene's vision, pharmacy, and hybrid specialty products are out of scope for Phase I, II, & III CORE Certification. Claims for these products are wholly owned and processed by OptiCare Managed Vision, US Script, and Celtic Insurance Company respectively. As of June 2014, Centene is working to migrate claim processing for its vision and pharmacy products into its CORE-certified system. Centene will notify CAQH CORE when this migration has been completed. Centene's hybrid specialty product, for which claims are wholly owned and processed by Celtic Insurance Company, will remain out of scope.

8 Triple-S Salud: Triple-S Salud's previously offered Medicare Advantage product is out of scope for the CAQH CORE Operating Rules. As of December 31, 2013, all claims for BCBS PR Medicare Advantage are owned and processed by Triple-S Advantage, which is a separate legal entity from Triple-S Salud.