General CAQH CORE FAQs

II. Introduction to CORE Participation

1. How can entities become involved in the CAQH CORE Operating Rules development process?

CAQH CORE uses an open, transparent process to draft its operating rules and any entity is welcome to join this process. Currently, over 140 entities, representing different stakeholder types, participate in CAQH CORE Operating Rules development. The CAQH CORE Operating Rules are developed in a phased approach that establishes milestones to encourage feasible progress in resolving industry business needs while minimizing barriers to implementation. The CAQH CORE Governing Procedures establish a multistage voting process for development and approval of the CAQH CORE Operating Rules.

Participation in CAQH CORE rule-making is open to any interested healthcare stakeholder, including health plans, providers, technology companies, government entities, trade associations, vendors, and standard-setting organizations. Please refer to the CAQH CORE Participation Application for information on how to become a CAQH CORE Participating Organization.

Only CAQH CORE Participating Organizations may directly vote on development of the CAQH CORE Operating Rules. Non-CAQH CORE Participating Entities can contribute at various stages of the process such as during public surveys asking for input, in response to Public CAQH CORE Town Hall calls or via the CMS process for comment on proposed operating rule regulations.

2. How is CAQH CORE Participation different from CORE Certification and CORE Endorsement?

CAQH CORE Participating Organizations support the rule-making process by providing expertise and input through a collaborative, transparent process. Participation in the CAQH CORE rules development process is open to any interested healthcare stakeholder, including health plans, providers, technology companies, government entities, trade associations, vendors, financial institutions, and standard-setting organizations. Only organizations that join CAQH CORE as Participants may contribute to the CAQH CORE rules development process via CAQH CORE Subgroup and Work Group efforts. See the CAQH CORE Participation Application for further information.

CORE Certification means an entity has demonstrated its conformance with the CAQH CORE Operating Rules by signing a CAQH CORE Certification Pledge committing its IT systems to perform according to the CAQH CORE Operating Rules and completing certification testing with a CAQH CORE-authorized testing vendor. Entities that have successfully completed both CAQH CORE Certification Testing and CAQH CORE review will receive a CORE Certification Seal for the appropriate phase of CAQH CORE Operating Rules. Once an entity obtains its respective CORE Certification Seal, it can market itself as CORE-certified.

CORE Endorsement is available for entities that do not create, transmit, or use administrative healthcare transactions, and therefore cannot implement the CAQH CORE Operating Rules. CORE Endorser Organizations demonstrate their support for the CAQH CORE mission and the CAQH CORE Operating Rules by signing the CAQH CORE Endorser Pledge for the appropriate phase and applying for the respective CORE Endorser Seal. Endorsers may or may not be CAQH CORE Participating organizations; there is no fee to obtain the CORE Endorser Seal.

For more information on CORE Certification and CORE Endorsement, see the CAQH CORE FAQs Part G: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement.

3. How do I become a CAQH CORE Participant?

CAQH CORE Participation is open to any interested healthcare stakeholder, including health plans, providers, technology companies, government entities, trade associations, vendors, and standard-setting organizations. See CAQH CORE Participating Organizations for a list of current participants. Please refer to the CAQH CORE Participation Application for information on how to become a CAQH CORE Participant.

4. Do all CAQH CORE Participating Organizations or CORE-certified entities contract with one another (become trading partners) by participating in CAQH CORE?

No. CAQH CORE will not be involved in trading partner relationships, will not dictate contractual relationships between trading partners, and will not determine with whom and how health plans/providers/vendors/others conduct their contracting. This includes entities that decide to become CORE-certified. This said, some entities that are CORE-certified require their trading partners to become CORE-certified, but that is the choice of that entity, it is not CAQH CORE policy. See the CAQH CORE Certification Policies (Phase I, Phase II, Phase III, & Phase IV) for more information.

For more information on CORE Certification and CORE Endorsement, see the CAQH CORE FAQs Part G: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement.