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.

Endorser organizations who receive the seal support the goals of the initiative and bring value to their members, customers, clients and patients through their knowledge of and commitment to efficient healthcare data exchange.

Organization	Certified RULE SETS	Certification Status
Aetna, Inc	Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals (Infrastructure Only) Health Care Claims	Active Active Active Active Active
Alabama Medicaid Agency	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Alaska Department of Health and Social Services	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
All Savers Insurance	Eligibility & Benefits Claim Status	Active Active
American Postal Workers Union Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Anthem	Eligibility & Benefits Claim Status	Active Active
Anthem Colorado*	Eligibility & Benefits Claim Status	Active Active
Anthem Connecticut*	Eligibility & Benefits Claim Status	Active Active
Anthem Indiana*	Eligibility & Benefits Claim Status	Active Active
Anthem Kentucky*	Eligibility & Benefits Claim Status	Active Active
Anthem Maine*	Eligibility & Benefits Claim Status	Active Active
Anthem Nevada*	Eligibility & Benefits Claim Status	Active Active
Anthem New Hampshire*	Eligibility & Benefits Claim Status	Active Active
Anthem Ohio*	Eligibility & Benefits Claim Status	Active Active
Anthem Virginia*	Eligibility & Benefits Claim Status	Active Active
AultCare	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Blue Cross Blue Shield of California*	Eligibility & Benefits Claim Status	Active Active
Blue Cross Blue Shield of Georgia*	Eligibility & Benefits Claim Status	Active Active
Blue Cross Blue Shield of Missouri*	Eligibility & Benefits Claim Status	Active Active
Blue Cross Blue Shield of Nebraska*	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Blue Cross Blue Shield North Carolina*	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Blue Cross Blue Shield of Tennessee*	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Blue Cross Blue Shield of Wisconsin*	Eligibility & Benefits Claim Status	Active Active
CalOptima	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
CareSource	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Centene Corporation	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Cigna⁷	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Contra Costa Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Delta Dental of California	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental of Delaware	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental District of Columbia	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental Insurance Company	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental of New Your	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental of Pennsylvania	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental of Puerto Rico	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
^Delta Dental of West Virginia	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Dentegra	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Empire Blue Cross Blue Shield*	Eligibility & Benefits Claim Status	Active Active
Excellus Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Golden Rule Insurance Company	Eligibility & Benefits Claim Status	Active Active
Harvard Pilgrim Health Care	Eligibility & Benefits Claim Status	Active Active
Health Net	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Horizon Blue Cross Blue Shield of New Jersey	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Humana¹	Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals (Infrastructure Only) Health Care Claims Benefit Enrollment Premium Payment	Active Active Active Active Active Active Active
Inland Empire Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Kaiser Permanente Colorado	Eligibility & Benefits Claim Status	Active Active
Kaiser Permanente Washington	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Medical Mutual of Ohio	Eligibility & Benefits Claim Status	Active Active
MVP Health Care	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
National Association of Letter Carriers Health Benefit Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
New Hampshire Medicaid	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
North Dakota Health & Human Services	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Palmetto GBA	Payment & Remittance	Active
Partnership Health Plan	Eligibility & Benefits Claim Status	Active Active
PrimeWest Health	Eligibility & Benefits Claim Status	Active Active
Sanford Health Plan	Eligibility & Benefits Claim Status	Active Active
Security Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Sutter Health Plus	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Texas Medicaid	Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals (Infrastructure only) Health Care Claims	Active Active Active Active Active
Trillium Community Health Plan	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Tufts Health Plan	Eligibility & Benefits Claim Status	Active Active
United Healthcare Life Insurance Company	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
United Health Group²	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active

Organization		CERTIFIED RULE SETS	CERTIFICATION STATUS
U.S Department of Veterans Affairs		Eligibility & Benefits	Active

Organization Product	CERTIFIED RULE SETS	CERTIFICATION STATUS
Ability CHOICE All-Payer Claims	Eligibility & Benefits	Active
Alight Solutions, LLC Connections Eligibility EDI 834 5010 File	Benefit Enrollment	Active
ASSERTUS ASSERTUS Clearinghouse	Eligibility & Benefits Claim Status	Active Active
Availity, LLC Availity Health Information Network	Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals (Infrastructure only) Health Care Claims	Active Active Active Active Active
Claim.MD Claim.MD	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Conduent EDI Solutions, Inc. Conduent EDI Direct	Eligibility & Benefits Claim Status	Active Active
Eligible Eligible	Eligibility & Benefits Claim Status Payment & Remittance Health Care Claims	Active Active Active Active
eMEDIX eMEIDIX Clearinghouse Eligibility	Eligibility & Benefits Claim Status	Active Active
eProvider Solutions eProvider Solutions	Eligibility & Benefits Claim Status	Active Active
Experian Health OneSource	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
GE Healthcare Centricity EDI Clearinghouse	Eligibility & Benefits Claim Status	Active Active
HEALTHeLink HEALTHeNET	Eligibility & Benefits Claim Status	Active Active
HFMI LLC maxRTE	Eligibility & Benefits	Active
HMS HMS	Eligibility & Benefits	Active
Inmediata Health Group Corp. Inmediata Clearinghouse	Eligibility & Benefits Claim Status	Active Active
InstaMed InstaMed Network	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
NaviNet NaviNet	Eligibility & Benefits Claim Status	Active Active
Office Ally Clearinghouse	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Optum Insight Medical Network	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Oracle Health HDXTS	Eligibility & Benefits	Active
Pay Span PaySpanHealth.com	Payment & Remittance	Active
PNT Data EDI Services & Clinical Data Services	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
pVerify pVerify	Eligibility & Benefits Claim Status	Active Active
RealMed Corporation RealMed Revenue Cycle Management	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
Retrace Clearinghouse+	Eligibility & Benefits Claim Status Payment & Remittance Health Care Claims	Active Active Active Active
Smart Data Solutions Smart Data Stream Clearinghouse	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
FinThrive, Inc. Insurance Clearinghouse	Eligibility & Benefits Claim Status	Active Active
The SSI Group, Inc Access Director V 3.5	Prior Authorization & Referrals (Infrastructure only)	Active
The SSI Group, Inc ClickON E-Verify Suite	Eligibility & Benefits Claim Status	Active Active
The SSI Group, Inc ClickON Remittance Module	Payment & Remittance	Active
TriZetto Provider Solutions Integrated Eligibility & Integrated Claim Status Inquiry	Eligibility & Benefits Claim Status	Active Active
TriZetto Provider Solutions CORE III version 2	Payment & Remittance	Active
UHIN uTRANSEND v2.0	Eligibility & Benefits Claim Status Payment & Remittance	Pending Pending Pending
National Electronic Attachment, Inc. Vyne Dental Clearinghouse Services	Eligibility & Benefits	Active

ORGANIZATION		RULE SETS
Accenture		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
American Academy of Family Physicians		Eligibility & Benefits Claim Status
American Association of Preferred Provider Organizations		Eligibility & Benefits
American College of Physicians		Eligibility & Benefits
American Health Information Management Association		Eligibility & Benefits
American Medical Association		Claim Status
Calpion		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
CalRHIO		Eligibility & Benefits
CamCare		Eligibility & Benefits
Center for Health Transformation		Eligibility & Benefits Claim Status
Claredi		Eligibility & Benefits
Cognizant		Eligibility & Benefits Claim Status
Cognosante		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
Edifecs, Inc.		Eligibility & Benefits
eHealth Initiative		Eligibility & Benefits
EHNAC		Eligibility & Benefits
emids Technologies		Eligibility & Benefits Claim Status Payment & Remittance
Enclarity, Inc.		Eligibility & Benefits
FISGlobal		Eligibility & Benefits Claim Status
Foresight Corporation		Eligibility & Benefits Claim Status
Greater New York Hospital Association		Eligibility & Benefits
Healthcare Financial Management Association		Eligibility & Benefits
Healthcare Information and Management Systems Society		Eligibility & Benefits
HIPAA QA, Inc.		Eligibility & Benefits Claim Status
IRIS Health Services		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
IRIS Technologies		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
Links2Success		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
Methodical		Eligibility & Benefits Claim Status
Medical Group Management Association		Eligibility & Benefits Claim Status
Medical Practice Software, Inc.		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
Michigan Public Health Institute		Eligibility & Benefits
Microsoft		Eligibility & Benefits
MultiPlan		Eligibility & Benefits
Musculoskeletal Imaging Consultants LLC		Eligibility & Benefits Claim Status
NACHA		Eligibility & Benefits Claim Status
Pillsbury Winthrop Shaw Pittman, LLP		Eligibility & Benefits
Qualedix		Eligibility & Benefits Claim Status
Smart Card Alliance		Eligibility & Benefits Claim Status
SCG Health		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
SunCoast RHIO		Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals Health Care Claims Benefit Enrollment Premium Payment
URAC		Eligibility & Benefits
Virtusa		Prior Authorization & Referrals
WEDI		Eligibility & Benefits
Data Dimensions		Eligibility & Benefits Claim Status


athenahealth athenaCollector	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
CVS Health Pharmacy Benefit Management Division	Payment & Remittance	Active
SS&C Health SS&C Health	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
ECHO Health, Inc. National EFT/ERA Simplicity Payment Solution v8.1	Payment & Remittance	Active
Mphasis HEALTHpac	Eligibility & Benefits Claim Status	Active Active
Mphasis Javelina	Eligibility & Benefits Claim Status	Active Active
FrontRunnerHC FrontRunnerHC	Eligibility & Benefits Claim Status	Active Active
GE Healthcare Centricity Business Version 4.0 and Version 4.3	Eligibility & Benefits	Active
GE Healthcare Centricity Business Version 5.0 Eligibility/Benefits	Eligibility & Benefits Claim Status	Active Active
GE Healthcare Financial Risk Manager Version 6.1	Eligibility & Benefits Claim Status Payment & Remittance	Active Active Active
HealthTrio Smart Series	Eligibility & Benefits Claim Status Payment & Remittance Prior Authorization & Referrals (Infrastructure Only) Health Care Claims Benefit Enrollment	Active Active Active Active Active Active
Intellisight Technology, Inc. FieldWorker	Health Care Claims Prior Authorization & Referrals	Active Active
Medical Present Value, Inc. (MPV) MPV Eligibility	Eligibility & Benefits	Active
NextGen Healthcare NextGen® Practice Management(Small & Group Practices)	Eligibility & Benefits Claim Status	Active
Revenue Management Solutions, LLC (RMS)	Payment & Remittance	Active
The SSI Group Inc ClickON E-Verify Suite	Eligibility & Benefits Claim Status	Active Active
Veuu Incorporated payVeuu	Payment & Remittance	Active
XIFIN XIFIN RPM	Eligibility & Benefits Claim Status	Active Active
Zelis™ Payments Zelis ACH	Payment & Remittance	Active

*Indicates an Anthem, Inc. company

^Indicates affiliates to Delta Dental of California

CORE Health Plan IT Exemptions & Out of Scope Designations:

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).

CORE-Certified Organizations/Products

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