CORE-certified Organizations (Pending and Current)

CORE-Certified Organizations/Products

CAQH CORE certifies and awards CORE Certification Seals to entities that create, transmit or use the administrative 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 the CAQH CORE Operating Rules for a specific transaction. Voluntary CORE Certification is available for providers, health plans, clearinghouses, and product vendors.

Organizations that do not create, transmit, or use administrative healthcare transactions, and therefore cannot implement the CAQH CORE Operating Rules, can demonstrate their support for the CORE mission and vision and operating rules by applying for and using the CORE Endorser Seal. View endorser organizations by visiting the CORE Endorsers page.

HEALTH PLANS
PROVIDERS
CLEARINGHOUSES
VENDORS

Organization		Certified Phases (Committed Phases)
Aetna, Inc.		Eligibility & Benefits Claim Status Payment & Remittance
Alabama Medicaid Agency		Eligibility & Benefits Claim Status Payment & Remittance
Alameda Alliance for Health		Eligibility & Benefits Claim Status Payment & Remittance
Alaska Department of Health and Social Services		Eligibility & Benefits Claim Status Payment & Remittance
All Savers Insurance		Eligibility & Benefits Claim Status
American Postal Workers Union Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Anthem		Eligibility & Benefits Claim Status
Anthem Colorado*		Eligibility & Benefits Claim Status
Anthem Connecticut*		Eligibility & Benefits Claim Status
Anthem Indiana*		Eligibility & Benefits Claim Status
Anthem Kentucky*		Eligibility & Benefits Claim Status
Anthem Maine*		Eligibility & Benefits Claim Status
Anthem Nevada*		Eligibility & Benefits Claim Status
Anthem New Hampshire*		Eligibility & Benefits Claim Status
Anthem Ohio*		Eligibility & Benefits Claim Status
Anthem Virginia*		Eligibility & Benefits Claim Status
AultCare		Eligibility & Benefits Claim Status Payment & Remittance
AvMed Health Plans		Eligibility & Benefits Claim Status
Blue Cross of California*		Eligibility & Benefits Claim Status
Blue Cross Blue Shield of Georgia*		Eligibility & Benefits Claim Status
Blue Cross Blue Shield of Missouri*		Eligibility & Benefits Claim Status
Blue Cross Blue Shield of Nebraska³		Eligibility & Benefits Claim Status Payment & Remittance
Blue Cross Blue Shield of North Carolina		Eligibility & Benefits Claim Status Payment & Remittance
BlueCross BlueShield of Tennessee		Eligibility & Benefits Claim Status Payment & Remittance
Blue Cross Blue Shield of Wisconsin*		Eligibility & Benefits Claim Status
Boston Medical Center Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
CalOptima		Eligibility & Benefits Claim Status Payment & Remittance
Centene Corporation⁵		Eligibility & Benefits Claim Status Payment & Remittance
Cigna⁷		Eligibility & Benefits Claim Status Payment & Remittance
ConnectiCare		Eligibility & Benefits Claim Status Payment & Remittance
Contra Costa Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
County of Riverside - Exclusive Care		Eligibility & Benefits Claim Status
DAKOTACARE		Eligibility & Benefits Claim Status Payment & Remittance
Delta Dental of California		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental of Delaware		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental District of Columbia		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental Insurance Company		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental of New York		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental of Pennsylvania		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental of Puerto Rico		Eligibility & Benefits Claim Status Payment & Remittance
^Delta Dental of West Virginia		Eligibility & Benefits Claim Status Payment & Remittance
Dentegra		Eligibility & Benefits Claim Status Payment & Remittance
EmblemHealth		Eligibility & Benefits Claim Status Payment & Remittance
Empire Blue Cross Blue Shield*		Eligibility & Benefits Claim Status
Excellus Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
First Medical Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Florida Division of Medicaid		Eligibility & Benefits Claim Status Payment & Remittance
Georgia Department of Community Health		Eligibility & Benefits Claim Status Payment & Remittance
Gold Coast Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Golden Rule Insurance Company		Eligibility & Benefits Claim Status
Government Employees Health Association		Eligibility & Benefits Claim Status
Harvard Pilgrim Health Care		Eligibility & Benefits Claim Status
Health Plan of San Joaquin		Eligibility & Benefits Claim Status Payment & Remittance
Health Plan of San Mateo		Eligibility & Benefits Claim Status Payment & Remittance
HealthNet		Eligibility & Benefits Claim Status Payment & Remittance
Healthplex		Eligibility & Benefits Claim Status
Horizon Blue Cross Blue Shield of New Jersey		Eligibility & Benefits Claim Status Payment & Remittance
Humana¹		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
Inland Empire Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Kaiser Permanente Colorado		Eligibility & Benefits Claim Status
Kaiser Permanente Washington		Eligibility & Benefits Claim Status Payment & Remittance
MaineCare		Eligibility & Benefits Claim Status Payment & Remittance
Medical Card Systems		Eligibility & Benefits
Medical Mutual of Ohio		Eligibility & Benefits Claim Status Payment & Remittance (Q4 2020)
MVP Health Care		Eligibility & Benefits Claim Status Payment & Remittance
National Association of Letter Carriers Health Benefit Plan		Eligibility & Benefits Claim Status Payment & Remittance
Nebraska Medicaid		Eligibility & Benefits Claim Status Payment & Remittance
New Hampshire Medicaid		Eligibility & Benefits Claim Status
North Dakota Department of Human Services		Eligibility & Benefits Claim Status Payment & Remittance
Oklahoma Healthcare Authority		Eligibility & Benefits (Q4 2020) Claim Status (Q4 2020)
Oklahoma Office of Management and Enterprise Services: Employees Group Insurance Division		Eligibility & Benefits Claim Status Payment & Remittance
Partnership Health Plan		Eligibility & Benefits Claim Status Payment & Remittance (Q4 2020)
Physicians Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
PrimeWest Health		Eligibility & Benefits Claim Status
Priority Health		Eligibility & Benefits Claim Status Payment & Remittance
Providence Health Plan		Eligibility & Benefits Claim Status Payment & Remittance (Q4 2020)
Public Employees Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Rocky Mountain Health Plans⁴		Eligibility & Benefits Claim Status Payment & Remittance
San Francisco Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Santa Clara Family Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Security Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
SummaCare		Eligibility & Benefits Claim Status Payment & Remittance
Sutter Health Plus		Eligibility & Benefits Claim Status Payment & Remittance
Texas Medicaid		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims
Trillium Commmunity Health Plan		Eligibility & Benefits Claim Status Payment & Remittance
Triple-S Salud ⁶ BlueCross BlueShield of Puerto Rico		Eligibility & Benefits Claim Status Payment & Remittance
Tufts Health Plan		Eligibility & Benefits Claim Status
UnitedHealthcare Life Insurance Compay		Eligibility & Benefits Claim Status Payment & Remittance
UnitedHealth Group²		Eligibility & Benefits Claim Status Payment & Remittance
University of Pittsburgh Medical Center		Eligibility & Benefits Claim Status Payment & Remittance

Organization		Certified Phases (Committed Phases)
Mayo Clinic		Eligibility & Benefits
Montefiore Medical Center		Eligibility & Benefits Claim Status
Solstas Lab Partners Group, LLC		Eligibility & Benefits
Summit Medical Group		Eligibility & Benefits
U.S. Department of Veterans Affairs		Eligibility & Benefits
Wake Forest University Health Sciences		Eligibility & Benefits

Organization Product		Certified Phases (Committed Phases)
Ability CHOICE All-Payer Claims		Eligibility & Benefits Claim Status
AdminisTEP, LLC AdminisTEP Next Generation Clearinghouse including Eligibility and Claim Status		Eligibility & Benefits
ASSERTUS ASSERTUS Clearinghouse		Eligibility & Benefits Claim Status
Availity, LLC Availity Health Information Network		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims
Avizzor Health Solutions Clearinghouse		Eligibility & Benefits Claim Status
Capario Phoenix Processing System		Eligibility & Benefits Claim Status
Cerner/Healthcare Data Exchange HDX		Eligibility & Benefits Claim Status
Change Healthcare Real Time and Batch Transaction Processing and Data Hosting Service RelayExchange^TM		Eligibility & Benefits Claim Status
Change Healthcare Remittance and Payment Management		Payment & Remittance
ClaimRemedi ClaimRemedi by eSolutions		Eligibility & Benefits Claim Status
Conduent EDI Solutions, Inc. Conduent EDI Direct		Eligibility & Benefits Claim Status
Dorado Systems doradoConnect by eSolutions		Eligibility & Benefits Claim Status
Dorado Systems doradoVerify		Eligibility & Benefits Claim Status
Eligible Eligible		Eligibility & Benefits Claim Status Payment & Remittance
eMEDIX eMEDIX Clearinghouse Eligibility		Eligibility & Benefits
eProvider Solutions eProvider Solutions		Eligibility & Benefits Claim Status
eServices Group Inc. Unite		Eligibility & Benefits Claim Status
Experian Health OneSource		Eligibility & Benefits Claim Status Payment & Remittance
GE Healthcare Centricity EDI Clearinghouse		Eligibility & Benefits Claim Status
HEALTHeLink HEALTHeNET		Eligibility & Benefits Claim Status
HeW Revenue Cycle Management & EDI Services		Eligibility & Benefits Claim Status Payment & Remittance
HealthFusion HealthFusion® Real-Time		Eligibility & Benefits Claim Status
HMS HMS		Eligibility & Benefits
InstaMed InstaMed Network		Eligibility & Benefits Claim Status Payment & Remittance
MD On-Line, Inc. ACCE$$ Patient Eligibility Verification		Eligibility & Benefits Claim Status
NaviNet NaviNet		Eligibility & Benefits Claim Status
Navicure Eligibility		Eligibility & Benefits Claim Status
Office Ally Office Ally Clearinghouse		Eligibility & Benefits Claim Status Payment & Remittance
Optum Optum360		Payment & Remittance
OptumInsight Optum Netwerkes		Eligibility & Benefits Claim Status
OptumInsight Optum Transaction Exchange		Eligibility & Benefits Claim Status
Pay Span PaySpanHealth.com		Payment & Remittance
PNT Data EDI Services & Clinical Data Services		Eligibility & Benefits Claim Status Payment & Remittance
PokitDok PokitDok Platform		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims
Practice Insight EDIinsight by eSolutions		Eligibility & Benefits Claim Status
RealMed Corporation RealMed Revenue Cycle Management		Eligibility & Benefits Claim Status Payment & Remittance
Inmediata Health Group Corp. Inmediata Clearinghouse		Eligibility & Benefits Claim Status
Smart Data Solutions Smart Data Stream Clearinghouse		Eligibility & Benefits Claim Status Payment & Remittance
Surescripts Surescripts Prescription Benefit		Eligibility & Benefits
TransUnion Healthcare, LLC Insurance Clearinghouse		Eligibility & Benefits Claim Status
The SSI Group, Inc Access Director V 3.5		Prior Authorization & Referrals
The SSI Group, Inc ClickON E-Verify Suite		Eligibility & Benefits Claim Status
The SSI Group, Inc ClickON Remittance Module		Payment & Remittance
TriZetto Provider Solutions Integrated Eligibility & Integrated Claim Status Inquiry		Eligibility & Benefits Claim Status
TriZetto Provider Solutions CORE III version 2		Payment & Remittance
UHIN uTRANSEND v2.0		Eligibility & Benefits (Q4 2020) Claim Status (Q4 2020)
Waystar Claims Management		Payment & Remittance
WorkCompEDI Clearinghouse		Health Care Claims
ZirMed Eligibility Verification		Eligibility & Benefits

Organization Product		Certified Phases (Committed Phases)
ABILITY EligibilityOne		Eligibility & Benefits Claim Status
athenahealth athenaCollector		Eligibility & Benefits Claim Status Payment & Remittance
Automated HealthCare Solutions (AHCS)/ezVerify and Validate ezVerify		Eligibility & Benefits
Cooperative Managed Care Services, LLC		Eligibility & Benefits Claim Status Payment & Remittance
CSC CSC DirectConnect®		Eligibility & Benefits
CVS Health Pharmacy Benefit Management Division		Payment & Remittance
Datavi P3NET		Payment & Remittance
SS&C Health PowerSTEPP		Eligibility & Benefits Claim Status Payment & Remittance
ECHO Health, Inc. National EFT/ERA Simplicity Payment Solution v8.1		Payment & Remittance
Eldorado, Inc. HEALTHpac CORE Real-Time Application		Eligibility & Benefits Claim Status
Eldorado, Inc. Javelina Real-Time		Eligibility & Benefits Claim Status
Eligibill Eligibill II		Eligibility & Benefits Claim Status
EmergingHealth TREKS		Eligibility & Benefits
eServices Group, Inc. XJ Series Gateway Services		Eligibility & Benefits Claim Status
EIXSYS EIXSYS GATEWAY		Eligibility & Benefits Claim Status
FrontRunnerHC FrontRunnerHC		Eligibility & Benefits Claim Status
GE Healthcare Centricity Business Version 4.0 and Version 4.3		Eligibility & Benefits
GE Healthcare Centricity Business Version 5.0 Eligibility/Benefits		Eligibility & Benefits Claim Status
GE Healthcare Financial Risk Manager Version 6.1		Eligibility & Benefits Claim Status Payment & Remittance
Gi4 Gi4		Eligibility & Benefits Claim Status
HealthTrio Smart Series		Eligibility & Benefits Claim Status Payment & Remittance
HIPAAsuite HIPAA Claim Payment Master		Payment & Remittance
HIPAAsuite HIPAA RealTime Server		Eligibility & Benefits Claim Status
ikaSystems ikaClaims version 5.X suite		Eligibility & Benefits Claim Status
Loxogon Loxogon Alloy™		Eligibility & Benefits
McKesson/Change Healthcare RelayPayer Connectivity Services (PCS)		Eligibility & Benefits Claim Status Payment & Remittance
McKesson/Change Healthcare RelayClearance™ Plus Version 4.6		Eligibility & Benefits Claim Status
Medical Informatics Engineering WebChart EMR		Eligibility & Benefits
Medical Present Value, Inc. (MPV) MPV Eligibility		Eligibility & Benefits
MEDITECH EDI Eligibility Validation - Version Client/Server 5.66		Eligibility & Benefits Claim Status
MEDITECH Claim Status Inquiry and Response - Version Client/Server 5.66		Claim Status
MEDITECH Electronic Claim Submission/Remittance - Version Client/Server 5.66		Payment & Remittance
NextGen Healthcare NextGen® Practice Management (Small & Group Practices)		Eligibility & Benefits Claim Status
NoMoreClipboard.com NoMoreClipboard.com		Eligibility & Benefits
NTT DATA Services, LLC NTT DATA Services		Eligibility & Benefits Claim Status
Orbograph Healthcare Payments Automation Center (HPAC)		Payment & Remittance
Phreesia Phreesia		Eligibility & Benefits Claim Status
PNC Remittance Advantage		Payment & Remittance
Recondo Technology SurePayHealth		Eligibility & Benefits Claim Status
The SSI Group Inc ClickON E-Verify Suite		Eligibility & Benefits Claim Status
Tallan T-Connect		Eligibility & Benefits Claim Status
Ventanex Provider Pay Application		Payment & Remittance
Zelis™ Payments Zelis ACH		Payment & Remittance

*Indicates an Anthem, Inc. company

^Indicates affiliates to Delta Dental of California

CORE Health Plan IT Exemptions & Out of Scope Designations:

Exemptions: The CAQH CORE Exemption Policy allows a health plan seeking voluntary CORE Certification to request that a scheduled migration of an existing IT system(s) or recent mergers at the time of CORE Certification be exempt from CAQH CORE Conformance. Health plan exemptions will be granted only if:

The exempted system affects no more than 30% of the health plan's membership or total electronic remittance advice plus electronic payment transactions and

The remainder of the health plan's IT systems is in conformance with all applicable CAQH CORE Operating Rule requirements.

A documented plan is in place for the exempted IT system(s) to be brought into conformance with the CAQH CORE Operating Rules.

The CAQH CORE Exemption Policy requires that within 12 months of the health plan's CORE Certification all exempt systems must be remediated to operate in conformance with the applicable CAQH CORE Operating Rules.

Out of Scope Designations: Out of Scope Designations are applied when claims are fully owned and processed by another organization and, therefore, the CAQH CORE Operating Rules cannot be applied by the certifying health plan (i.e., member data for the product is wholly owned by the external organization). If a health plan touches the administrative data but outsources some processing to a Business Associate(s), an Out of Scope Designation does not apply.

Exemptions & Out of Scope Designations for CORE-certified Health Plans 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).

⁵ Centene Corporation: Centene's vision, pharmacy, and hybrid specialty products are out of scope for Eligibility & Benefits, Claim Status, and Payment & Remittance CORE Certification. Claims for these products are wholly owned and processed by OptiCare Managed Vision, US Script, and Celtic Insurance Company respectively. As of June 2014, Centene is working to migrate claim processing for its vision and pharmacy products into its CORE-certified system. Centene will notify CAQH CORE when this migration has been completed. Centene's hybrid specialty product, for which claims are wholly owned and processed by Celtic Insurance Company, will remain out of scope. ⁶ Triple-S Salud: Triple-S Salud's previously offered Medicare Advantage product is out of scope for the CAQH CORE Operating Rules. As of December 31, 2013, all claims for BCBS PR Medicare Advantage are owned and processed by Triple-S Advantage, which is a separate legal entity from Triple-S Salud.

Type:

Membership/Participant list

Audience:

Public

Organization Type:

Health plans

CAQH CORE Participant Calendar

View the CORE Recertification Webinar

Join CORE

For more information on CORE or to inquire about participation in CORE, email: CORE@caqh.org.

CORE Certification

Voluntary CORE Certification is available for providers, health plans, clearinghouses, and product vendors that demonstrate its IT system or product is operating in conformance with a specific phase(s) of the CAQH CORE Operating Rules.

Learn more.

Contact CAQH CORE

core@caqh.org