Frequently Asked Questions - i. CORE Certification Testing Overview

My organization is a vendor with a solution/product that sends benefit enrollment & maintenance information (834) to HIPAA-covered health plans

Submitted by caqh_admin on Thu, 12/24/2015 - 05:26
Who should undergo CORE Certification testing?

All organizations seeking CORE Certification that create, transmit, or use the administrative transactions addressed by the CAQH CORE Operating Rules will have to undergo CAQH CORE Certification Testing to obtain a CORE Certification Seal for a specific phase of CAQH CORE Operating Rules. 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 Thu, 12/24/2015 - 05:27
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 phase 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 stakeholder-specific CORE Certification Seal.

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What and who are CAQH CORE-authorized testing vendors?

Submitted by caqh_admin on Thu, 12/24/2015 - 05:28
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 Thu, 12/24/2015 - 05:28
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 Thu, 12/24/2015 - 05:30
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 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 see HERE or contact core@caqh.org

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How much does CAQH CORE Certification Testing cost?

Submitted by caqh_admin on Thu, 12/24/2015 - 05:31
How much does CORE Certification testing cost?

Certification testing costs are determined by each CAQH CORE-authorized testing vendor and are subject to change. See here for a list of the CAQH CORE-authorized testing vendors and links to their web pages which list their respective certification testing fees. Separately, CAQH charges a one-time fee, per phase, for the CORE Certification Seal.

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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 Thu, 12/24/2015 - 05:32
What do I do with my successful 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 your desired 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 Thu, 12/24/2015 - 05:32
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 (e.g., the provider names, etc.) as shown in the CAQH CORE Master Test Bed Data, can valid information about their organization be used instead when generating the required X12 270 i

Submitted by caqh_admin on Thu, 12/24/2015 - 05:33
When a provider does not wish to load test information into their system (e.g., the provider names, etc.) as shown in the CAQH CORE Master Test Bed Data, can valid information about their organization be used instead when generating the required X12 270 inquiries during CORE Certification testing?

Yes, a provider should have no difficulty substituting currently valid data such as their own provider name, address information, including identifiers into the 270 documents submitted to a CAQH CORE-authorized testing vendor for CORE Certification testing. Some of the Phase I and Phase II 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 both Phase I and Phase II CORE Certification testing.

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