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CORE-Certified Organizations/Products

CAQH CORE certifies providers, health plans, clearinghouses, and vendors that use the healthcare transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity's IT system or product conforms with the operating rules for a specific business process.

Endorser organizations who receive the seal support the goals of the initiative and bring value to their members, customers, clients and patients through their knowledge of and commitment to efficient healthcare data exchange.

Organization   Certified RULE SETS Certification Status
Aetna, Inc Aetna Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure Only)
  • Health Care Claims
  • Active
  • Active
  • Active
  • Active
  • Active
Alabama Medicaid Agency Alabama Medicaid Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Alaska Department of Health and Social Services Alaska Dept Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
All Savers Insurance All Savers Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
American Postal Workers Union Health Plan APWU Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Anthem Anthem Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Colorado*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Connecticut*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Indiana*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Kentucky*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Maine*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Nevada*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem New Hampshire*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Ohio*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Anthem Virginia*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
AultCare AultCare Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield of California*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Blue Cross Blue Shield of Georgia*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Blue Cross Blue Shield of Missouri*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Blue Cross Blue Shield of Nebraska* Blue Cross Nebraska Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield North Carolina* Blue Cross North Carolina Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield of Tennessee* Blue Cross North Carolina Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield of Wisconsin*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
CalOptima  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Centene Corporation Centene Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Cigna 7 Cigna Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Contra Costa Health Plan Contra Costa Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Delta Dental of California  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental of Delaware  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental District of Columbia  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental Insurance Company  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental of New Your  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental of Pennsylvania  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental of Puerto Rico  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
^Delta Dental of West Virginia  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Dentegra  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Empire Blue Cross Blue Shield*  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Excellus Health Plan Excellus Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Golden Rule Insurance Company Golden Rule Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Harvard Pilgrim Health Care Harvard Pilgrim Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Health Net Health Net Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Horizon Blue Cross Blue Shield of New Jersey  Horizon Blue Cross Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Humana1  Humana Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure Only)
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
  • Active
  • Active
  • Active
  • Active
  • Active
  • Active
  • Active
Inland Empire Health Plan  Inland Empire Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Kaiser Permanente Colorado  Kaiser Permanente Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Kaiser Permanente Washington  Kaiser Permanente Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Medical Mutual of Ohio  Medical Mutual Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
MVP Health Care  MVP Health Care Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
National Association of Letter Carriers Health Benefit Plan  HBP Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
New Hampshire Medicaid  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
North Dakota Health & Human Services  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Palmetto GBA  
  • Payment & Remittance
  • Active
Partnership Health Plan  Partnership Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Physicians Health Plan  Physicians Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
PrimeWest Health  PrimeWest Health Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Rock Mountain Health Plans4 Rocky Mountain Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Sanford Health Plan  
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Security Health Plan Security Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Sutter Health Plus Sutter Health Plus Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Texas Medicaid  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure only)
  • Health Care Claims
  • Active
  • Active
  • Active
  • Active
  • Active
Trillium Community Health Plan  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Tufts Health Plan Tufts Health Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
United Healthcare Life Insurance Company United Healthcare Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
United Health Group2 UnitedHealth Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Organization   CERTIFIED RULE SETS CERTIFICATION STATUS
U.S Department of Veterans Affairs
  • Eligibility & Benefits
  • Active
Organization Product   CERTIFIED RULE SETS CERTIFICATION STATUS
Ability
CHOICE All-Payer Claims
Ability Logo
  • Eligibility & Benefits
  • Active
AdminisTEP, LLC
AdminisTEP Next Generation
Clearinghouse including Eligibility and
Claim Status
Adminis Logo
  • Eligibility & Benefits
  • Active
Alight Solutions, LLC
Connections Eligibility EDI 834 5010 File
 
  • Benefit Enrollment
  • Active
ASSERTUS
ASSERTUS Clearinghouse
Assertus Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Availity, LLC
Availity Health Information Network
Availity Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure only)
  • Health Care Claims
  • Active
  • Active
  • Active
  • Active
  • Active
Cerner/Healthcare Data Exchange
HDX
 
  • Eligibility & Benefits
  • Active
Claim.MD
Claim.MD
Claim MD Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Conduent EDI Solutions, Inc.
Conduent EDI Direct
Conduent Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Dorado Systems
doradoConnect by eSolutions
Dorado Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Dorado Systems
doradoVerify
Dorado Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Eligible
Eligible
Eligible Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
eMEDIX
eMEIDIX Clearinghouse Eligibility
eMEDIX Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
eProvider Solutions
eProvider Solutions
eProvider Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Experian Health
OneSource
Experian Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
GE Healthcare
Centricity EDI Clearinghouse
GE Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Healthcare IP
Healthcare IP
 
  • Eligibility & Benefits
  • Active
HEALTHeLink
HEALTHeNET
 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
HeW
Revenue Cycle Management & EDI Services
HEW Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
HealthFusion
HealthFusion® Real-Time
HealthFusion Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
HFMI LLC
maxRTE
maxRTE Logo
  • Eligibility & Benefits
  • Active
HMS
HMS
HMS Logo
  • Eligibility & Benefits
  • Active
Inmediata Health Group Corp.
Inmediata Clearinghouse
Inmediata Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
InstaMed
InstaMed Network
Instamed Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
NaviNet
NaviNet
NaviNet Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Navicure
Eligibility
Navicure Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Office Ally
Clearinghouse
Office Ally Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Optum Insight
Medical Network
Optum Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Pay Span
PaySpanHealth.com
PaySpan Logo
  • Payment & Remittance
  • Active
PNT Data
EDI Services & Clinical Data Services
PNTData Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
pVerify
pVerify
 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
RealMed Corporation
RealMed Revenue Cycle Management
RealMed Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Retrace
Clearinghouse+
retrace Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Health Care Claims
  • Active
  • Active
  • Active
  • Active
Smart Data Solutions
Smart Data Stream Clearinghouse
Smart Data Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
FinThrive, Inc.
Insurance Clearinghouse
FinThrive Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
The SSI Group, Inc
Access Director V 3.5
SSI Logo
  • Prior Authorization & Referrals (Infrastructure only)
  • Active
The SSI Group, Inc
ClickON E-Verify Suite
SSI Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
The SSI Group, Inc
ClickON Remittance Module
SSI Logo
  • Payment & Remittance
  • Active
TriZetto Provider Solutions
Integrated Eligibility & Integrated Claim Status Inquiry
TriZetto Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
TriZetto Provider Solutions
CORE III version 2
TriZetto Logo
  • Payment & Remittance
  • Active
UHIN
uTRANSEND v2.0
 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Pending
  • Pending
  • Pending
National Electronic Attachment, Inc.
Vyne Dental Clearinghouse Services
Vyne Logo
  • Eligibility & Benefits
  • Active
Waystar
Claims Management
Waystar Logo
  • Payment & Remittance
  • Active
ZirMed
Eligibility Verification
Waystar Logo
  • Eligibility & Benefits
  • Active
ORGANIZATION   RULE SETS
Accenture
  • Eligibility & Benefits 
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
American Academy of Family Physicians
  • Eligibility & Benefits
  • Claim Status
American Association of Preferred Provider Organizations
  • Eligibility & Benefits
American College of Physicians
  • Eligibility & Benefits
American Health Information Management Association
  • Eligibility & Benefits
American Medical Association
  • Claim Status
Calpion
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
CalRHIO
  • Eligibility & Benefits
CamCare
  • Eligibility & Benefits
Center for Health Transformation    
  • Eligibility & Benefits
  • Claim Status
Claredi
  • Eligibility & Benefits
Cognizant
  • Eligibility & Benefits
  • Claim Status
Cognosante
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
Edifecs, Inc.
  • Eligibility & Benefits
eHealth Initiative
  • Eligibility & Benefits
EHNAC
  • Eligibility & Benefits
emids Technologies
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
Enclarity, Inc.
  • Eligibility & Benefits
FISGlobal
  • Eligibility & Benefits
  • Claim Status
Foresight Corporation
  • Eligibility & Benefits
  • Claim Status
Greater New York Hospital Association
  • Eligibility & Benefits
Healthcare Financial Management Association
  • Eligibility & Benefits
Healthcare Information and Management Systems Society
  • Eligibility & Benefits
HIPAA QA, Inc.    
  • Eligibility & Benefits
  • Claim Status
IRIS Health Services
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
IRIS Technologies
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
Links2Success    
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
Methodical
  • Eligibility & Benefits
  • Claim Status
Medical Group Management Association
  • Eligibility & Benefits
  • Claim Status
Medical Practice Software, Inc.
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
Michigan Public Health Institute
  • Eligibility & Benefits
Microsoft
  • Eligibility & Benefits
MultiPlan
  • Eligibility & Benefits
Musculoskeletal Imaging Consultants LLC    
  • Eligibility & Benefits
  • Claim Status
NACHA
  • Eligibility & Benefits
  • Claim Status
Pillsbury Winthrop Shaw Pittman, LLP    
  • Eligibility & Benefits
Qualedix
  • Eligibility & Benefits
  • Claim Status
Smart Card Alliance    
  • Eligibility & Benefits
  • Claim Status
SCG Health    
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
SunCoast RHIO
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals
  • Health Care Claims
  • Benefit Enrollment
  • Premium Payment
URAC    
  • Eligibility & Benefits
Virtusa    
  • Prior Authorization & Referrals
WEDI
  • Eligibility & Benefits
Data Dimensions Data Dimensions Logo
  • Eligibility & Benefits
  • Claim Status
       
athenahealth
athenaCollector
Athena Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Automated HealthCare Solutions (AHCS)/ezVerify and Validate
ezVerify
Automated Healthcare Logo
  • Eligibility & Benefits
  • Active
CVS Health
Pharmacy Benefit Management Division
CVS Health Pharmacy Benefit Management Division
  • Payment & Remittance
  • Active
SS&C Health
SS&C Health
SS&C Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
ECHO Health, Inc.
National EFT/ERA Simplicity Payment Solution v8.1
Echo Health Logo
  • Payment & Remittance
  • Active
Eldorado, Inc.
HEALTHpac CORE Real-Time Application
Eldorado Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Eldorado, Inc.
Javelina Real-Time
Eldorado Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Eligibill
Eligibill II
Eligibill Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
EmergingHealth
TREKS
EmergingHealth Logo
  • Eligibility & Benefits
  • Active
FrontRunnerHC
FrontRunnerHC
FrontRunner Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
GE Healthcare
Centricity Business Version 4.0 and Version 4.3
GE Healthcare Logo
  • Eligibility & Benefits
  • Active
GE Healthcare
Centricity Business Version 5.0 Eligibility/Benefits
GE Healthcare Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
GE Healthcare
Financial Risk Manager Version 6.1
 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
HealthTrio
Smart Series
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure Only)
  • Health Care Claims
  • Benefit Enrollment
  • Active
  • Active
  • Active
  • Active
  • Active
  • Active
ikaSystems
ikaClaims version 5.X suite
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Intellisight Technology, Inc.
FieldWorker
FieldWorker Logo
  • Health Care Claims
  • Prior Authorization & Referrals
  • Active
  • Active
Loxogon
Loxogon Alloy™
Loxogon Logo
  • Eligibility & Benefits
  • Active
Medical Present Value, Inc. (MPV)
MPV Eligibility
  • Eligibility & Benefits
  • Active
NextGen Healthcare
NextGen® Practice Management(Small & Group Practices)
NextGen Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
NoMoreClipboard.com
NoMoreClipboard.com
NoMoreClipboard Logo
  • Eligibility & Benefits
  • Active
Orbograph
Healthcare Payments Automation Center (HPAC)
Orbograph
  • Payment & Remittance
  • Active
Recondo Technology
SurePayHealth
Recondo Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
The SSI Group Inc
ClickON E-Verify Suite
SSI Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Veuu Incorporated
payVeuu
 
  • Payment & Remittance
  • Active
XIFIN
XIFIN RPM
XIFIN Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Zelis™ Payments
Zelis ACH
  • Payment & Remittance
  • Active
*Indicates an Anthem, Inc. company
^Indicates affiliates to Delta Dental of California

CORE Health Plan IT Exemptions & Out of Scope Designations:

System Exemptions:

7Cigna: System migrations are underway to ensure the following Cigna products run over Payment & Remittance CORE-certified platforms: Qualcare and Qualcare Delivery System Alliances. These products cover less that 1% of Cigna's membership.

Out of Scope Designations:

1 Humana: Humana Military Healthcare Services (HMHS) and Humana Puerto Rico, covering approximately 30% of Humana's membership, are out of scope for the Eligibility & Benefits, Claim Status, and Payment & Remittance 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.

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

3 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).

4 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 & Benefits and Claim Status Operating Rules. Claims for these products are owned and processed by Delta Dental (for Dental product) and VSP (for Vision product).