Frequently Asked Questions - ii. CORE Recertification Overview

How long does my certification remain active?

Submitted by tfuchs@caqh.org on Tue, 03/01/2022 - 10:34
How long does my certification remain active?

Once certified, CORE-certified entities must remain conformant with applicable CAQH CORE Operating Rules throughout any system upgrades. An entity’s CORE Certification Seal will remain valid for 3 years, based off the year the certification was awarded. Entities are required to complete the recertification process in order to renew its CORE Certification Seal.

Further, A CORE-certified entity may become de-certified and have their CORE Certification Seal revoked if instances of non-conformance are found and not remedied or if there is a 180-day lapse in renewing certification.

In instances of mergers, acquisitions, or deployment of new systems:

  • If a CORE-certified entity is acquired by an entity that is not CORE-certified, the newly merged company will only be allowed to be CORE-certified if the acquired company is the only business that is applicable to the CAQH CORE Operating Rules. If this is not the case, then the newly merged company will be required to seek certification.
  • If a CORE-certified entity acquires or develops new system(s) that are not CORE-certified, the CORE-certified entity will have 12 months to certify the new system(s); if the CORE-certified entity does not certify the new system(s), it will lose its CORE Certification Seal.
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What is the overall process, expected timelines, and requirements for recertification?

Submitted by tfuchs@caqh.org on Tue, 03/01/2022 - 10:35
What is the overall process, expected timelines, and requirements for recertification?
  1. Recertification is required every three years for an entity to remain CORE-certified.
  2. Recertification renewals may occur anytime during the calendar year, based off initial year of certification.
  3. At a minimum, entities must implement versions of CAQH CORE Operating Rules that were published 24 months prior to the CORE Certification Seal renewal date.
  4. Entities seeking to maintain their certification status must complete the CAQH CORE Recertification Application Form within the recertification renewal year. After the CAQH CORE Recertification Form is completed, an entity must complete recertification testing within 180 days. The CAQH CORE Recertification Application Form communicates an entity’s intent to pursue recertification, collects contact information and identifies payment information for renewal of the CORE Certification Seal.
  5. Entities seeking CORE Certification will be charged a fee for the CORE Certification Seal (Certification Fee) as determined by CAQH CORE. CORE-certified entities renewing their CORE Certification Seals will be charged a fee for recertification (Recertification Fee) as determined by CAQH CORE.
  6. Recertification requires demonstration of successful testing by a CAQH CORE-authorized Testing Vendor.
  7. CAQH CORE will grant renewal of the CORE Certification Seal after an entity submits all documentation required: CAQH CORE Recertification Application Form, CORE Recertification Fee, recertification testing results, CAQH CORE HIPAA Attestation and any other supplemental materials requested by CAQH CORE.
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