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CORE Overview Presentation


CORE Provider Presentation

CORE State Information

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The map below depicts the percentage of lives commercially covered by a CAQH CORE Phase I-certified health plan. 


View a large/printable map.

State Activities 

State-based approaches to reducing healthcare costs are emerging, and CAQH is working to encourage CORE’s national approach:

  • California
    CAQH has and is continuing to present CORE to multiple CA stakeholders, including the state government.
  • Colorado
    Effective October 1, 2010, (in Proposed New Regulation 4-2-32) the Colorado Department of Regulatory Agencies Division of Insurance requires carriers licensed in Colorado as of September 1, 2012 to "show the ability of their systems to allow real time data exchange including benefits eligibility, coverage determinations, and other appropriate provider-carrier transactions and interoperability following all CORE guidelines for data formats and system requirements." Carriers are required to become CORE Phase II certified within one year of completing certification for CORE Phase I. The new regulation also requires all carriers and providers to uniformly use the CORE data content and infrastructure rules in the exchange of HIPAA compliant healthcare information and infrastructure improvements.

    The development results from a multi-stakeholder Work Group that was formed (as mandated by SB 135) to discuss implementation of standard health ID cards and provide recommendations regarding the electronic exchange of healthcare information. The final report from the Work Group recommended that the CORE rules be used by payers, providers, and vendors to improve interoperability and streamline the exchange of administrative healthcare information.
  • Massachusetts
    A community-based collaboration is identifying healthcare administrative complexities that generate unnecessary expenses for providers, payers, and employers. Eligibility has been identified as a key area needing improvement and CAQH has been asked to provide education on CORE.
  • Ohio
    The Ohio Advisory Committee on Eligibility and Real Time Claim Adjudication recommends adoption of the CAQH Committee on Operating Rules for Information Exchange (CORE) rules in its January 2009 Report on Eligibility and Real Time Claim Adjudication (pursuant to HB125, section 7). The CORE rules are to be used for payer and provider exchanges of patient eligibility information. Additionally, CAQH has been communicating with a broad range of stakeholders regarding the potential role for the CORE rules in Ohio's HIE plans.
  • Tennessee
    CAQH is working with state-based HIEs/RHIOs regarding the role they could serve as catalysts for administrative simplification.
  • Texas
    In its December 2008 Report and Recommendations Relating to the Facilitation of Electronic Health Insurance Data Exchange (pursuant to HB 522), the Texas Committee on Electronic Data Exchange recommends insurers in the state of Texas use the CAQH CORE Phase I rules. The CORE Phase I rules are to be used for electronically exchanging eligibility information. In 2009, the Texas Legislature or DOI is expected to address the committee recommendations.
  • Virginia
    A multi-stakeholder, industry-led effort, with state involvement, has endorsed CORE.
  • Washington
    Provisions in SB 5346 establish authority for the Insurance Commissioner to designate one or more lead organizations to coordinate the development of streamlined healthcare administration. CAQH staff has been working with the key stakeholders to provide information about both the CAQH Universal Provider DataSource (UPD) and CORE.
  • Wisconsin
    Administrative simplification efforts are in early stages. CAQH is providing education on CORE.

CORE and Federal HITECH Alignment 


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