Any health plan seeking CORE Certification must undergo certification testing for all functions it offers that are covered by the set of CAQH CORE Operating Rules for which the health plan is seeking certification. When a health plan outsources some functions to a clearinghouse, both the health plan and the clearinghouse to which the functions are outsourced will need to undergo CORE Certification testing in order for the health plan to become CORE-certified.
In this case, a health plan (and/or provider) can chose the “Not Applicable” option for any certification testing requirement for which it has outsourced the function, provided it uploads a rationale statement explaining why a certain test script is not applicable. For example, if a vendor offers connectivity services for a health plan, the rationale statement would include that Vendor X will be providing this functionality on the health plan’s behalf, so the plan does not need to undergo testing. Vendor X must then undergo CORE Certification testing for this function as a health plan clearinghouse. Both the health plan and the vendor may each test independently using different CAQH CORE-authorized testing vendors.
