My organization is a Vendor with a solution/product that sends the premium payment (ASC X12 820) to HIPAA-covered health plans, but doesn’t process or conduct any other transactions. Can my solution become CORE-certified if it only sends this transaction?

The Premium Payment operating rules related to the ASC X12 focus on the infrastructure flow between the health plan and sender. There are no CAQH CORE Premium Payment Operating Rules that apply to only senders of the premium payment transaction (820), so there are no associated test scripts or tasks for the CORE Certification Testing.

My organization is a HIPAA-covered Health Plan. Which CAQH CORE Premium Payment Operating Rule requirements does my organization have to test for in order to achieve CORE Certification on the CAQH CORE Premium Payment Operating Rule set?

A Health Plan seeking CORE Certification on the CAQH CORE Premium Payment Operating Rules must undergo CORE Certification Testing in accordance with the Premium Payment CAQH CORE Certification Test Suite  for:

Subscribe to viii. Premium Payment CORE Certification Testing