Clearinghouses and IT Vendors Join Rapidly Growing List of Entities Becoming CAQH CORE Certified

Business partners help health plans meet ACA requirements and promote secure and efficient exchange of administrative data

WASHINGTON, DC - 6/9/16

Health plan trading partners are increasingly seeking CORE Certification as a way to help their clients improve administrative processes and meet Affordable Care Act (ACA) requirements, according to the CAQH Committee on Operating Rules for Information Exchange (CORE).  CAQH CORE has awarded nearly 300 Certifications to date, nearly half of which are to entities that facilitate efficient electronic transactions for health plans.   

“Operating rules and standards work best when everyone involved in a transaction adheres to them,” said Cate McConnell, Director of Product Management, Payer Services, McKesson/Relay Health.  “By becoming CORE-certified, we are helping our clients meet – and exceed – an important regulatory mandate, while contributing to a more efficient healthcare system for everyone.”

The ACA mandated the creation of operating rules to enhance data sharing and support the seamless flow of billions of administrative transactions across the healthcare system. The Act required all health plans adhere to the operating rules, and directed the US Department of Health and Human Services (HHS) to create a certification program to verify compliance with the rules and underlying standards.  In 2014, HHS proposed designating CAQH CORE as the certifying entity for the program. Although that rulemaking is still pending, the number of CAQH CORE Certifications and formal pledges makes it the most widely recognized and trusted seal of approval in the industry.

Today, health plans increasingly rely on vendors, third party administrators, and other entities, commonly referred to as trading partners, to process claims, confirm eligibility, exchange funds, and share information with providers. Hospitals and physician groups similarly partner with practice management companies, clearinghouses and other vendors to operate efficiently. By becoming CORE-certified, these business partners are helping their clients meet the ACA operating rules mandate and are leading the way to a more efficient, secure and seamless healthcare data ecosystem.

“The business of healthcare is now highly interdependent,” said Carroll Midgett, Chief Operating Manager, American Postal Workers Union, Health Plan. “Widespread adoption of CORE Certification by all participants in the flow of healthcare administrative information is essential to achieve our nation’s goals of interoperability and efficiency, and we expect our business partners to be CORE-certified.”

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.  Four phases of CAQH CORE Operating Rules have been issued to date, 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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