CORE Certification is offered by CAQH CORE. CORE Certification means an organization has demonstrated its IT system or product, is operating in conformance with applicable requirements of a specific set(s) of the CAQH CORE Operating Rules via certification testing through a CAQH CORE-authorized testing Vendor.
Organizations pursuing CORE Certification can become certified on the CAQH CORE Operating Rules for Eligibility & Benefits, Claim Status, Payment Remittance, Prior Authorization & Referrals, Health Care Claims, Benefit Enrollment, and/or Premium Payment.
After an organization successfully completes the CORE Certification process, it can market itself as Eligibility & Benefits, Claim Status, Payment Remittance, Prior Authorization & Referrals, Health Care Claims, Benefit Enrollment and/or Premium Payment CORE-certified, as appropriate.
For more information about CORE Certification, please refer to the CORE Certification: Step-By-Step Process webpage.
- CORE Certification does not replace trading partner relationships.
- To ensure providers experience the benefits that arise from the adoption of the CAQH CORE Operating Rules, CAQH CORE encourages small providers to consider requesting/requiring that their vendor is CORE-certified. However, if a provider is capable of seeking CORE Certification independently, we encourage them to do so.