Frequently Asked Questions - i. CORE Certification Testing Overview

Does my organization have to undergo testing as part of CORE Certification?

Submitted by caqh_admin on Wed, 01/06/2021 - 12:53
Does my organization have to undergo testing as part of CORE Certification?

All organizations seeking CORE Certification that create, transmit, or use the administrative transactions addressed by the CAQH CORE Operating Rules will have to undergo CORE Certification Testing to obtain a CORE Certification Seal for any applicable CAQH CORE Operating Rule Sets. All parties essential to the success of the transactions are addressed in the CORE Certification Testing process: providers, health plans, clearinghouses, and vendors. CORE Certification Testing varies by stakeholder type.

Organizations that do not create, transmit, or use administrative data, such as associations and medical societies, are not eligible for CORE Certification. However, such organizations may demonstrate their support for CAQH CORE’s mission and operating rules by signing the CORE Endorser Pledge and applying for and using the CORE Endorser Seal. See “What does it mean to be a CORE Endorser?” for more information on CORE Endorsement.

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Why is testing required for CORE Certification?

Submitted by caqh_admin on Wed, 01/06/2021 - 12:54
Why is testing required for CORE Certification?

CORE Certification testing is required to confirm that entities comply with all of the CAQH CORE Operating Rules for the applicable transaction types for which they are being certified. Successful completion of stakeholder-specific testing, demonstrated through proper documentation from a CAQH CORE-authorized testing vendor, is the prerequisite for obtaining a transaction(s)-specific CORE Certification Seal.

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What is required for CORE Recertification Testing?

Submitted by caqh_admin on Wed, 01/06/2021 - 12:55
What is required for CORE Recertification Testing?

Recertification testing follows the same process as initial CORE Certification Testing. For recertification, organizations will have to conform to testing requirements as outlined in the CORE Certification Test Suites. However, to help reduce the testing burden for organizations, CAQH CORE has made some of the testing requirements optional for recertification testing:

  • Eligibility & Benefits: Testing tasks for operating rule requirements related to batch processing mode, batch acknowledgements and MIME connectivity are optional and not required.
  • Claim Status: Testing tasks for operating rule requirements related to batch processing mode, batch acknowledgements and MIME connectivity are optional and not required.
  • Payment & Remittance: Testing tasks for operating rule requirements related to MIME connectivity are optional and not required.

For questions related to recertification testing reach out to core@caqh.org to review recertification testing requirements.

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What and who are CAQH CORE-authorized testing vendors?

Submitted by caqh_admin on Wed, 01/06/2021 - 12:57
What and who are CAQH CORE-authorized testing vendors?

CAQH CORE-authorized testing vendors are IT companies that have expertise in healthcare transaction testing. They are chosen by CAQH CORE to conduct CORE Certification testing for all of the CAQH CORE Operating Rules using the CORE-approved Test Suite after a rigorous selection process by CAQH CORE, especially the CORE Certification/Testing Subgroup. Alpha and Beta testing of their CORE Certification Testing Platform is checked by CORE Participants to ensure it aligns with the CAQH CORE Master Test Suites, which have test scripts for each rule that are developed and finalized by the CORE Participants.

NOTE: CORE Certification and certification testing are separate activities. Certification testing is performed by entities seeking CORE Certification and supported by CAQH CORE-authorized testing vendors. CORE Certification is completed by CAQH CORE after an entity has successfully completed certification testing with a CAQH CORE-authorized testing vendor.

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Can any organization become a CAQH CORE-authorized Testing Vendor?

Submitted by caqh_admin on Wed, 01/06/2021 - 12:58
Can any organization become a CAQH CORE-authorized Testing Vendor?

Yes. CAQH CORE conducts a review and selection process with interested organizations prior to approval as a CAQH CORE-authorized testing vendor. Interested entities should contact CORE@caqh.org.

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What is the process for an organization to become a CAQH CORE-authorized Testing Vendor?

Submitted by caqh_admin on Wed, 01/06/2021 - 13:01
What is the process for an organization to become a CAQH CORE-authorized Testing Vendor?

An organization that wishes to achieve the distinction of being a CAQH CORE-authorized Testing Vendor must complete the following four steps:

Step 1. Learn. Develop a thorough understanding of the:

 Step 2. Build. Develop an on-line testing tool that uses the CAQH CORE Certification Test Suites and the appropriate Master Test Bed Data where applicable. The timeframe for the build is based on the vendor’s resource allocation and commitment to the project.

 Step 3. Service. Develop a customer service plan with established staffing and service levels. It is essential that staffing and service levels meet or exceed best market practices.

 Step 4. CAQH CORE Review. The functionality of the vendor’s CAQH CORE site is tested by both CAQH CORE staff and CORE-certified organizations through a formal testing process which includes Alpha and Beta Testing. 

For more information on the steps above, as well as additional considerations for organizations seeking to become a CAQH CORE-authorized Testing Vendor, please contact core@caqh.org

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How much does CAQH CORE Certification & Recertification Testing cost?

Submitted by caqh_admin on Wed, 01/06/2021 - 13:03
How much does CAQH CORE Certification & Recertification Testing cost?

Certification testing costs are determined by each CAQH CORE-authorized testing vendor and are subject to change. Separately, CAQH CORE charges a one-time fee, per operating rule set, for the CORE Certification Seal. Fees for Recertification will be ½ of the initial CORE Certification fee.

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Once I have tested with the CAQH CORE-authorized Testing Vendor, what do I do with my successful CAQH CORE Certification Testing results?

Submitted by caqh_admin on Wed, 01/06/2021 - 13:07
Once I have tested with the CAQH CORE-authorized Testing Vendor, what do I do with my successful CAQH CORE Certification Testing results?

The CORE Certification testing results provided to you by the CAQH CORE-authorized testing vendor are required to apply for a CORE Certification Seal. When your organization has successfully completed CORE Certification testing, submit the results to CAQH CORE, along with other required documentation, when applying for the CORE Certification Seal. Please see the CORE Certification Seal Application Form for more information.

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Is CORE Certification testing a “one shot" test or are there several iterations?

Submitted by caqh_admin on Wed, 01/06/2021 - 13:08
Is CORE Certification testing a “one shot" test or are there several iterations?

An organization can perform all or specific parts of the CORE Certification testing requirements as many times as needed. To see the tests required, view the CORE Certification Test Suites. Per the CORE Certification Policy, the number of times each test is undertaken by any entity is confidential information between the entity and the CAQH CORE-authorized testing vendor.

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When a provider does not wish to load test information into their system as shown in the CAQH CORE Master Test Bed Data, can valid information about their organization be used instead when generating the required transaction?

Submitted by jporras on Wed, 01/06/2021 - 13:54
When a provider does not wish to load test information into their system as shown in the CAQH CORE Master Test Bed Data, can valid information about their organization be used instead when generating the required transaction?

Yes, a provider should have no difficulty substituting currently valid data such as their own provider name, address information, including identifiers into the transaction documents submitted to a CAQH CORE-authorized testing vendor for CORE Certification testing. Some of the Eligibility & Benefits CAQH CORE Master Test Bed Data element values can be modified. These modifiable data elements and how they may be modified are specified in the CAQH CORE Master Test Bed Data for Eligibility & Benefits CORE Certification testing.

In order to become CORE-certified for any CAQH CORE Operating Rule set, an organization or product has to undergo CORE Certification Testing. Where do I go for CORE Certification Testing?

CORE Certification is conducted by CORE CAQH CORE-authorized Testing Vendors. The test sites of these authorized testing vendors use a CORE Participant approved set of test script and the site was beta tested by CORE participants.  Currently, there is only one CORE-authorized testing entity: Edifecs. Start here to register for Edifecs CORE Certification Testing on all CAQH CORE Operating Rule sets. 

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My organization is interested in pursuing CORE Certification, but a testing task in the CAQH CORE Certification Test Suite does not apply to my organization or its line of business. What do I do?

Submitted by jporras on Wed, 01/06/2021 - 13:59
My organization is interested in pursuing CORE Certification, but a testing task in the CAQH CORE Certification Test Suite does not apply to my organization or its line of business. What do I do?

In the CORE Certification Testing Site, create and submit a rationale statement regarding why the specific testing task does not apply to your organization/line of business. For instructions on how to create and submit an issue, check the CORE Certification Testing Quick Start Guides.

This rationale statement should clearly justify why the testing task or its associated operating rule requirements do not apply to your organization, your line of business, or how your organization conducts the transaction.

The CAQH CORE-authorized Testing Vendor will review the rationale statement with CAQH CORE Staff, and it will be evaluated whether the testing task is applicable to your organization, your line of business, or how your organization conducts the transaction. During review of the issue, more information, documentation, or discussion may be required of your organization, e.g., support that an operating rule requirement is outsourced to a business associate. After completion of the review, CAQH CORE Staff will ultimately communicate its decision to your organization.

If you need assistance in determining if a testing task is applicable to your organization or its line of business, contact CAQH CORE Staff at core@caqh.org

Note: Each stakeholder type applying for CORE certification must meet the applicable Operating Rule requirements should the requirement apply to their organization – the purpose of the rationale statement is not to ask for an exception or exemption on applicable requirements.

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