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.
Organization |
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Certified RULE SETS |
Certification STatus |
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Aetna, Inc. | ![]() |
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Alabama Medicaid Agency | ![]() |
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Alameda Alliance for Health |
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Alaska Department of
Health and Social Services
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All Savers Insurance | ![]() |
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American Postal Workers Union Health Plan | ![]() |
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Anthem | ![]() |
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Anthem Colorado* | ![]() |
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Anthem Connecticut* | ![]() |
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Anthem Indiana* | ![]() |
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Anthem Kentucky* | ![]() |
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Anthem Maine* | ![]() |
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Anthem Nevada* | ![]() |
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Anthem New Hampshire* | ![]() |
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Anthem Ohio* | ![]() |
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Anthem Virginia* | ![]() |
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AultCare | ![]() |
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Blue Cross of California* | ![]() |
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Blue Cross Blue Shield of Georgia* | ![]() |
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Blue Cross Blue Shield of Missouri* | ![]() |
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Blue Cross Blue Shield of Nebraska3 |
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Blue Cross Blue Shield of North Carolina | ![]() |
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BlueCross BlueShield of Tennessee | ![]() |
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Blue Cross Blue Shield of Wisconsin* | ![]() |
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Boston Medical Center Health Plan | ![]() |
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CalOptima |
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Centene Corporation | ![]() |
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Cigna7 |
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ConnectiCare | ![]() |
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Contra Costa Health Plan | ![]() |
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County of Riverside - Exclusive Care | ![]() |
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DAKOTACARE | ![]() |
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Delta Dental of California |
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^Delta Dental of Delaware |
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^Delta Dental District of Columbia |
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^Delta Dental Insurance Company |
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^Delta Dental of New York |
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^Delta Dental of Pennsylvania |
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^Delta Dental of Puerto Rico |
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^Delta Dental of West Virginia |
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Dentegra |
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EmblemHealth | ![]() |
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Empire Blue Cross Blue Shield* | ![]() |
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Excellus Health Plan
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First Medical Health Plan | ![]() |
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Florida Division of Medicaid
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Georgia Department of Community Health | ![]() |
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Gold Coast Health Plan | ![]() |
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Golden Rule Insurance Company | ![]() |
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Government Employees Health Association | ![]() |
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Harvard Pilgrim Health Care
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Health Plan of San Joaquin |
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Health Plan of San Mateo |
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Health Net | ![]() |
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Healthplex |
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Horizon Blue Cross Blue Shield of New Jersey | ![]() |
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Humana1 | ![]() |
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Inland Empire Health Plan | ![]() |
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Kaiser Permanente Colorado | ![]() |
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Kaiser Permanente Washington | ![]() |
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MaineCare
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Medical Card Systems |
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Medical Mutual of Ohio | ![]() |
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MVP Health Care | ![]() |
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National Association of Letter Carriers
Health Benefit Plan
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Nebraska Medicaid | ![]() |
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New Hampshire Medicaid |
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North Dakota Department of Human Services |
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Oklahoma Office of Management and
Enterprise Services: Employees Group
Insurance Division
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Partnership Health Plan | ![]() |
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Physicians Health Plan | ![]() |
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PrimeWest Health | ![]() |
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Priority Health |
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Providence Health Plan | ![]() |
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Public Employees Health Plan | ![]() |
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Rocky Mountain Health Plans4 | ![]() |
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Sanford Health Plan |
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San Francisco Health Plan | ![]() |
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Santa Clara Family Health Plan |
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Security Health Plan |
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SummaCare | ![]() |
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Sutter Health Plus | ![]() |
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Texas Medicaid |
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Trillium Commmunity Health Plan |
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Tufts Health Plan
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UnitedHealthcare Life Insurance Company | ![]() |
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UnitedHealth Group2 | ![]() |
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University of Pittsburgh Medical Center | ![]() |
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Organization |
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CERTIFIED RULE SETS |
CERTIFICATION STATUS |
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Summit Medical Group | ![]() |
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U.S. Department of Veterans Affairs | ![]() |
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Organization |
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CERTIFIED RULE SETS |
CERTIFICATION STATUS |
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Ability
CHOICE All-Payer Claims
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AdminisTEP, LLC
AdminisTEP Next Generation Clearinghouse including Eligibility and Claim Status
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Alight Solutions, LLC
Connections Eligibility EDI 834 5010 File
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ASSERTUS
ASSERTUS Clearinghouse
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Availity, LLC Availity Health Information Network |
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Avizzor Health Solutions Clearinghouse |
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Capario Phoenix Processing System |
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Cerner/Healthcare Data Exchange HDX |
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Change Healthcare
Real Time and Batch Transaction Processing and Data Hosting Service RelayExchangeTM
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Change Healthcare
Remittance and Payment Management
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Claim.MD Claim.MD |
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Conduent EDI Solutions, Inc. Conduent EDI Direct |
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Dorado Systems doradoConnect by eSolutions |
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Dorado Systems doradoVerify |
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Eligible Eligible |
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eMEDIX eMEDIX Clearinghouse Eligibility |
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eProvider Solutions |
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Experian Health OneSource |
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GE Healthcare Centricity EDI Clearinghouse |
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Healthcare IP Healthcare IP |
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HEALTHeLink HEALTHeNET |
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HeW Revenue Cycle Management & EDI Services |
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HealthFusion HealthFusion® Real-Time |
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HMS HMS |
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Inmediata Health Group Corp. Inmediata Clearinghouse |
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InstaMed InstaMed Network |
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GMG Management Consulting, Inc. |
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NaviNet NaviNet |
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Navicure Eligibility |
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Office Ally Office Ally Clearinghouse |
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Optum Optum360 |
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OptumInsight Optum Transaction Exchange |
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Pay Span
PaySpanHealth.com
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PNT Data EDI Services & Clinical Data Services |
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RealMed Corporation
RealMed Revenue Cycle Management |
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Retrace Clearinghouse+ |
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Smart Data Solutions Smart Data Stream Clearinghouse |
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FinThrive, Inc. Insurance Clearinghouse |
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The SSI Group, Inc Access Director V 3.5 |
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The SSI Group, Inc ClickON E-Verify Suite |
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The SSI Group, Inc ClickON Remittance Module |
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TriZetto Provider Solutions Integrated Eligibility & Integrated Claim Status Inquiry |
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TriZetto Provider Solutions CORE III version 2 |
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UHIN
uTRANSEND v2.0
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National Electronic Attachment, Inc.
Vyne Dental Clearinghouse Services
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Waystar Claims Management |
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Data Dimensions
Clearinghouse
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ZirMed Eligibility Verification |
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athenahealth athenaCollector |
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Automated HealthCare Solutions (AHCS)/ezVerify and Validate ezVerify |
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CVS Health |
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SS&C Health SS&C Health |
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ECHO Health, Inc. National EFT/ERA Simplicity Payment Solution v8.1 |
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Eldorado, Inc. HEALTHpac CORE Real-Time Application |
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Eldorado, Inc.
Javelina Real-Time
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Eligibill Eligibill II |
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EmergingHealth TREKS |
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eServices Group, Inc. XJ Series Gateway Services |
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EIXSYS EIXSYS GATEWAY |
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FrontRunnerHC FrontRunnerHC |
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GE Healthcare Centricity Business Version 4.0 and Version 4.3 |
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GE Healthcare Centricity Business Version 5.0 Eligibility/Benefits |
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GE Healthcare Financial Risk Manager Version 6.1 |
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Gi4 Gi4 |
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HealthTrio Smart Series |
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HIPAAsuite HIPAA Claim Payment Master |
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HIPAAsuite HIPAA RealTime Server |
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ikaSystems
ikaClaims version 5.X suite
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Intellisight Technology, Inc.
FieldWorker
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Loxogon Loxogon Alloy™ |
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McKesson/Change Healthcare RelayPayer Connectivity Services (PCS) |
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McKesson/Change Healthcare RelayClearance™ Plus Version 4.6 |
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Medical Present Value, Inc. (MPV) MPV Eligibility |
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MEDITECH
EDI Eligibility Validation - Version Client/Server 5.66
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MEDITECH
Claim Status Inquiry and Response - Version Client/Server 5.66
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MEDITECH
Electronic Claim Submission/Remittance - Version Client/Server 5.66
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NextGen Healthcare NextGen® Practice Management (Small & Group Practices) |
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NoMoreClipboard.com NoMoreClipboard.com |
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NTT DATA Services, LLC |
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Orbograph
Healthcare Payments Automation Center (HPAC)
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Phreesia Phreesia |
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PNC Remittance Advantage |
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Recondo Technology SurePayHealth |
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The SSI Group Inc ClickON E-Verify Suite |
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Tallan T-Connect |
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Ventanex Provider Pay Application |
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XIFIN XIFIN RPM |
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Zelis™ Payments |
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*Indicates an Anthem, Inc. company
^Indicates affiliates to Delta Dental of California
CORE Health Plan IT Exemptions & Out of Scope Designations:
CORE Health Plan IT Exemptions & 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).
Audience
Organization Type