Frequently Asked Questions - ii. CORE Certification Policies

What criteria must be met for a health plan to be eligible for an exemption under the CAQH CORE Health Plan IT System Exemption Policy?

Submitted by jporras on Wed, 01/06/2021 - 11:05
What criteria must be met for a health plan to be eligible for an exemption under the CAQH CORE Health Plan IT System Exemption Policy?

Any health plan seeking an exemption under the CAQH CORE Health Plan IT System Exemption Policy must meet the following criteria:

  • No more than 30 percent of a health plan’s total membership can be processed by the IT system(s) to be covered by the exemption.
  • Migration must be scheduled for completion no later than 12 months from the date of when the health plan is granted CORE Certification.

See the CAQH CORE Health Plan IT System Exemption Policy and CAQH CORE Health Plan IT Exemption Request Form for more information.

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