CORE Certification

CAQH awards CORE Certification Seals to entities that create, transmit or use the healthcare administrative and financial transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product, is operating in conformance with applicable requirements of a specific phase(s) of the CAQH CORE Operating Rules.

Operating Rules Mandate

The Patient Protection and Affordable Care Act (ACA), Section 1104 “…establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.” ACA Section 1104 requires the Secretary of the Department of Health and Human Services (HHS) to adopt and regularly update standards, implementation specifications, and operating rules for the electronic exchange and use of health information for the purposes of financial