Frequently Asked Questions - i. CORE Certification Testing Overview

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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