- About CAQH CORE
- Operating Rules
- New Operating Rule Structure
- Eligibility & Benefits
- Claim Status
- Payment & Remittance
- Prior Authorization & Referrals
- Health Care Claims
- Benefit Enrollment
- Premium Payment
- Mandated Operating Rules
- CORE Certification
- Priority Topics
- Join CAQH CORE
- Resource Library
- CAQH ProView
- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
- COB Smart
CAQH CORE Participant Calendar
Provider-Owned Health Plans Awarded CORE Certification
Boston Medical Center Health Plan, Providence Health Plan and UPMC Health Plan have completed testing and been awarded CORE certifications for Phases I-III of the CAQH CORE Operating Rules. Organizations in this rapidly growing part of the new healthcare economy are seeking CORE Certification to go above and beyond regulatory requirements and improve electronic data sharing.
According to a report by McKinsey & Company, today more than 15 million people are covered by provider-owned insurance plans in 39 states, and that number is growing. These plans combine both medical claims and clinical data enabling them to achieve economies of scale, manage risk and improve population health.
CORE Certification supports these goals by ensuring they exchange administrative data securely, accurately and efficiently.
“As a provider-owned health plan, we have a unique understanding of how critical it is for data to flow seamlessly and securely between payers, hospitals and other partners,” said Kim Sinclair, Chief Information Officer of Boston Medical Center Health Plan, part of the Boston Medical Center Health System.
Boston Medical Center is the primary teaching affiliate for Boston University School of Medicine and is the largest safety net hospital in New England.
“The CORE seal demonstrates to all of our partners our commitment to efficient data exchange and it enables us to identify partners that we can count on to do business efficiently, so we can focus on coordinating the care of our members,” added Sinclair.
To date, more than 300 certifications have been awarded to health plans, providers, vendors and clearinghouses.
Congratulations to recently certified entities in April and May 2017
eProvider Solutions, Phase I, II
Boston Medical Center Health Plan, Phase III