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About CAQH CORE
Drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability, and align administrative and clinical activities among providers, payers and consumers.
Press Release 11/04/15
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.
CORE Certification is for organizations that create, use or transmit administrative healthcare data (such as health plans, healthcare providers and vendors) CORE Certification verifies that an organization or product operates in agreement with the operating rules and the underlying standards, and is doing so with their trading partners.
CAQH CORE Operating Rules
ACA Section 1104 requires HIPAA covered entities to be in compliance with the remaining ACA-mandated operating rules.
- Health claims or equivalent encounter information
- Health plan enrollment/disenrollment
- Health plan premium payments
- Referral certification and authorization
- Health claims attachments