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.

Organization

 

Certified Phases
(Committed Phases)

Aetna, Inc.
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
Alabama Medicaid Agency Alabama Medicaid A
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
Alameda Alliance for Health  
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
Alaska Department of
Health and Social Services
Alaska Logo
  • 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 GEHA Logo
  • 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 MVP Healthcare
  • 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 Providence Health Plan Logo
  • 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 Security Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
SummaCare
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
Sutter Health Plus 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
Cerner
  • Eligibility & Benefits
  • Claim Status
 
 
Change Healthcare
Real Time and Batch Transaction Processing and Data Hosting Service
RelayExchangeTM
Change Healthcare Logo
  • Eligibility & Benefits
  • Claim Status
 
Change Healthcare
Remittance and Payment Management
Change Healthcare Logo
  • Payment & Remittance
 
ClaimRemedi
ClaimRemedi by eSolutions
 
ClaimRemedi Logo
  • 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
Eligible Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
 
eMEDIX
eMEDIX Clearinghouse Eligibility
  • Eligibility & Benefits
 

eProvider Solutions
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
SSI Group
  • Payment & Remittance
 
TriZetto Provider Solutions
Integrated Eligibility & Integrated Claim Status Inquiry
Trizetto III
  • Eligibility & Benefits
  • Claim Status
 
TriZetto Provider Solutions
CORE III version 2
Trizetto III
  • 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 Cooperative Managed Care Services Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
CSC
CSC DirectConnect®
  • Eligibility & Benefits

CVS Health
Pharmacy Benefit Management Division

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
FrontRunner Logo
  • 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
Gi4 Logo
  • Eligibility & Benefits
  • Claim Status
HealthTrio
Smart Series
HealthTrio Logo
  • 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)
Change Healthcare Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
McKesson/Change Healthcare
RelayClearance™ Plus Version 4.6
Change Healthcare Logo
  • 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)
Orbograph
  • 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.  
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