CAQH CORE Milestone: 200 Operating Rules Certifications Awarded to Healthcare Organizations

CORE Certification becomes the gold standard for electronic healthcare data exchange

WASHINGTON, DC - 11/4/15

The CAQH Committee on Operating Rules for Information Exchange (CORE®) today announced that it has awarded more than 200 CORE Certifications to health plans, hospitals and health systems, clearinghouses and vendors.  Widely regarded as a must-have seal of approval across the healthcare industry, CORE Certification signifies that these organizations follow a set of HIPAA-mandated standards and operating rules for exchanging electronic administrative data.

“Today we are announcing an important milestone in the effort to streamline administration and improve electronic data sharing across our nation’s healthcare system,” said George S. Conklin, Senior Vice President and Chief Information Officer, CHRISTUS Health and CAQH CORE Board Chair.  “It is vital that we have an independent certifying body for operating rules and standards and, with this achievement, there is no question CORE Certification is the gold standard.”

The Affordable Care Act mandated the creation of operating rules to improve the efficiency, accuracy and security of billions of healthcare administrative transactions and established stiff penalties to enforce them. In 2014, HHS proposed designating CAQH CORE as the certifying organization for health plans to demonstrate their adherence to the adopted standards and operating rules. Additional HHS activity on that rulemaking is expected soon.

CAQH CORE was formed in 2005 by healthcare organizations across government and industry to streamline healthcare data exchange through a common set of electronic data sharing rules. Created and maintained with broad multi-stakeholder input, the CORE Certification program works with independent testing entities to evaluate whether organizations applying for certification use information systems that conform to the standards and operating rules. Although CORE Certification is voluntary, health plans and hospital systems across the US are increasingly expecting their business partners to have earned the CORE Certification seal. In an environment of heightened enforcement, CAQH CORE helps organizations examine their own adherence as well as that of their partners. 

“The momentum of CORE Certifications reflects the increased commitment and mounting success of a multitude of players in healthcare to effectively share electronic data in secure and meaningful ways,” said Matthew Levesque, VP of Revenue Cycle Operations at athenahealth. “The work of CAQH CORE should be noted as a leading effort to bridge the gaps to information sharing.”

For health plans, the operating rules mean greater efficiency and security. Provider organizations using systems that adhere to the operating rules face fewer IT and administrative hassles and are able to dedicate more resources to patient care. For consumers, the operating rules hold the promise of a healthcare system with fewer frustrating paperwork errors, more secure information and lower costs.

“We seek business partners who are CORE-certified,” said Douglas E. Blackwell, Senior Vice President and Chief Information Officer for Horizon Healthcare Services, Inc. “It’s a key indicator to us of whether an organization or product is tested and trusted.”

Recently certified companies include:

  • Availity
  • Emdeon Inc.
  • Group Health Cooperative   
  • Blue Cross and Blue Shield of Nebraska
  • EmblemHealth
  • RelayHealth/McKesson

Click here for a complete list of CORE-certified organizations.

Click here to learn how to become CORE-certified.

About CAQH CORE

CAQH CORE was formed in 2005 to drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative activities among providers, payers and consumers.  Today, more than 140 organizations participate in CAQH CORE, including healthcare providers, health plans representing 75% of insured Americans, vendors, government entities, and standard setting organizations.  CAQH CORE Operating Rules were issued in four phases, and CORE Certification is currently available for Phases I, II and III Operating Rules. For more information, visit www.caqhcore.org.  

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