Become a CAQH CORE Participant

CAQH CORE Participation is open to any interested healthcare stakeholder, including health plans, providers, technology companies, government entities, trade associations, vendors and standard-setting organizations. Please refer to the CAQH CORE Participation Application for information on how to become a CAQH CORE Participant.

 

How Participating Organizations Can Engage in CAQH CORE Activities

  • Designate individuals to represent your organization perspective regarding issues being discussed by CAQH CORE.
    • Appoint staff or contractors to participate in workgroups to develop or maintain the CAQH CORE Operating Rules or other applicable groups.
    • Participate in research calls and meetings conducted by CAQH CORE to understand pain points and scope opportunity areas.
  • Assign someone to the implementation process in the event that your organization agrees to adopt the CAQH CORE Operating Rules or advocate for wider industry adoption of CAQH CORE Operating Rules.
  • Share insight and expertise in applicable areas through CAQH CORE Education activities.

 

Fee Structure

Stakeholder Type

Description

Fee

1

Commercial Health Plan

or

Vendor / Clearinghouse Member

Must create, transmit or use healthcare administrative data in daily business.
  • Below $75 million net annual revenue: $6,000 annual participation fee.
  • $75 million and above net annual revenue: $9,000 annual participation fee.

2

Healthcare Provider

Provider organizations that create, transmit or use healthcare administrative data in daily business.
  • Up to $1 billion in net annual revenue: $750 annual participation fee.
  • $1 billion - $3 billion in net annual revenue: $1,500 annual participation fee.
  • Over $3 billion in net annual revenue: $4,500 annual participation fee.

3

Association / Other

An organization representing stakeholders of the healthcare industry (including providers, health plans, or vendors / clearinghouses) or an advisory group / consultancy.
  • $2,250 annual participation fee.
4 Standards Organization A recognized standard setting organization or an entity whose primary purpose is to advise such organizations. 

N/A (no fee)

5

Government

Voting Government Member – Entity that exchanges information as it relates to administrative data transactions.

N/A (no fee)

Non-Voting Government Member – Entity that does NOT  exchange information as it realtes to administrative data transaction OR an entitiy that does but chooses not to participate in voting at the All CAQH CORE Participant Voting level.

N/A (no fee)
Type: 
Article
Audience: 
Public
Organization Type: 
Health plans
CAQH Program: 
CORE