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CAQH awards CORE Certification Seals to entities that create, transmit or use the healthcare administrative and financial transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product, is operating in conformance with applicable requirements of a specific phase(s) of the CAQH CORE Operating Rules.
In December 2017, the Center for Medicare and Medicaid Services (CMS) launched an administrative simplification pilot program to ensure companies are complying with adopted standards and operating rules. Becoming CORE certified is the best way to document, test and confirm that you are in conformance with the operating rules and ready for CMS audits.
If you are a health plan, provider, clearinghouse or vendor interested in information related to the CORE Certification please click HERE.
Organizations that do not create, transmit or use healthcare administrative and financial transactions, and therefore are ineligible for CORE Certification, can demonstrate their support for the CAQH CORE mission and Operating Rules by applying for and using the CORE Endorser Seal. Please refer to the CORE Endorser Seal: Application Process page for further information.