Certification: ACA Section 1104 Certification, CORE Certification, Proposed CORE HIPAA Credential, and CORE Endorsement

II. Introduction to CORE Certification

C. CORE Certification: Testing

iv. Phase III CORE Certification Testing

1. Is CORE Certification available for the Phase III CAQH CORE EFT & ERA Operating Rules?

Yes. Phase III CORE Certification is available for entities that use, conduct, or process the applicable X12 v5010 835 and Healthcare EFT Standards transactions. All necessary and relevant documents for Phase III CORE Certification are available on the CORE Certification webpage.

NOTES:

  • Organizations must complete CORE certification testing in succession (i.e., must be CORE-certified on the earlier phases to become certified on a higher phase of CAQH CORE Operating Rules). An entity may also undergo combined CORE Certification testing for all phases concurrently.
  • Entities seeking Phase III CORE Certification must demonstrate conformance with all applicable CAQH CORE EFT & ERA Operating Rules.
2. What is the purpose of the Phase III CAQH CORE Certification Master Test Suite?

The Phase III CAQH CORE Certification Master Test Suite Version 1.1.0 defines specific certification testing requirements and detailed test scripts for each of the CAQH CORE EFT & ERA Operating Rules to be completed by entities seeking CORE Certification. These detailed test scripts are not intended to exhaustively and comprehensively test all requirements of the CAQH CORE EFT & ERA Operating Rules; rather, they focus on a key subset of each rule’s requirements. CAQH CORE-authorized testing vendors use the scenarios and test scripts from the Phase III CAQH CORE Certification Master Test Suite in their CORE Certification testing products.

3. Does the Phase III CAQH CORE Certification Master Test Suite have to be used for certification on all Phase III CAQH CORE Operating Rules?

Yes, the Phase III CORE Certification Master Test Suite addresses each rule in the Phase III CAQH CORE EFT & ERA Operating Rules set. The CORE Certification Master Test Suite is used in order to maintain uniform testing processes and results and to gauge CAQH CORE Operating Rules conformance.

4. Do the test scripts in the Phase III CAQH CORE Certification Master Test Suite address all of the Phase III CAQH CORE Operating Rules?

Yes, each Phase III CAQH CORE Operating Rule has its own set of CORE Certification test scripts in the Phase III CAQH CORE Certification Master Test Suite. However,

CAQH CORE Certification Testing is not exhaustive. The CAQH CORE Certification Test Suites do not include comprehensive testing requirements that test for all possible permutations of each rule. 

5. Is there Master Test Bed Data required for Phase III CORE Certification?

No. There is no Master Test Bed Data for Phase III CORE Certification. All necessary documents to achieve Phase III CORE Certification are available on the CORE Certification Step-by-Step Process webpage.

NOTE: There is required CAQH CORE Master Test Bed Data for Phase I and Phase II CORE Certification. The Phase I and Phase II CAQH CORE Master Test Bed Data are available on the CAQH website as two separate files.