CORE-Certified Organizations/Products

View pending and current CORE certifications below. Voluntary CORE Certification is currently available for entities that exchange the X12 270/271 Eligibility & Benefits Request/Response and X12 276/277 Claim Status Inquiry/Response transactions, i.e., providers, health plans, clearinghouses, and vendors.

Organizations ready to adopt the CAQH CORE Operating Rules should click here to view recommended milestones for achieving voluntary CORE Phase II-certification.

View endorser organizations by visiting the CORE Endorsers page. Organizations that do not use, create, or transmit eligibility and/or claim status data can demonstrate their support for CORE’s mission and its rules by signing the CORE Pledge, and applying for and using the CORE Endorser Seal.

Health Plans

Organization		Certified Phase(s) (Committed Phase(s))
Aetna, Inc.		Phase I Phase II
Anthem Colorado*		Phase I Phase II
Anthem Connecticut*		Phase I Phase II
Anthem Indiana*		Phase I Phase II
Anthem Kentucky*		Phase I Phase II
Anthem Maine*		Phase I Phase II
Anthem Nevada*		Phase I Phase II
Anthem New Hampshire*		Phase I Phase II
Anthem Ohio*		Phase I Phase II
Anthem Virginia*		Phase I Phase II
AultCare		Phase I Phase II
AvMed Health Plans		Phase I
Blue Cross of California*		Phase I Phase II
Blue Cross Blue Shield of Georgia*		Phase I Phase II
Blue Cross Blue Shield of Missouri*		Phase I Phase II
Blue Cross Blue Shield of Nebraska4		Phase I Phase II
Blue Cross Blue Shield of North Carolina		Phase I (Phase II Committed)
BlueCross BlueShield of Tennessee		Phase I Phase II
Blue Cross Blue Shield of Wisconsin*		Phase I Phase II
Centene Corporation		(Phase I & II: Q2 2013)
Cigna		Phase I (Phase II: Q3 Committed)
Empire Blue Cross Blue Shield*		Phase I Phase II
Harvard Pilgrim Health Care		Phase I Phase II
HealthNet		Phase I Phase II
Horizon Blue Cross Blue Shield of New Jersey		(Phase I & II: Q3 2013)
Humana2		Phase I Phase II
Kaiser Permanente Colorado		Phase I (Phase II Committed)
Rocky Mountain Health Plans5		Phase I Phase II
UnitedHealth Group1 3		Phase I Phase II
WellPoint		Phase I Phase II

Providers

Organization		Certified Phase(s) (Committed Phase(s))
Mayo Clinic		Phase I (Phase II: Q2 2013)
Montefiore Medical Center		Phase I Phase II
Solstas Lab Partners Group, LLC		Phase I
Summit Medical Group		Phase I
U.S. Department of Veterans Affairs		Phase I
Wake Forest University Health Sciences		Phase I

Clearinghouses

Organization Product		Certified Phase(s) (Committed Phase(s))
Availity, LLC Availity Health Information Network		Phase I Phase II
Capario (Formerly MedAvant Healthcare Solutions) Phoenix Processing System		Phase I Phase II
Dorado Systems Insurance Validator		Phase I Phase II
Emdeon Inc. Real – Time Transaction Processing and Data Hosting Services		Phase I Phase II
eServices Group Inc. Unite		Phase I Phase II
Gateway EDI RTE Individual & Integrated Transactions		Phase I
HEALTHeNET HealtheNet		(Phase I: Q3 2013)
HealthFusion HealthFusion® Real-Time		Phase I Phase II
HMS HMS		Phase I
InstaMed InstaMed Platform and Network		Phase I Phase II
MD On-Line, Inc. ACCE$$ Patient Eligibility Verification		Phase I
NaviNet NaviNet		Phase I Phase II
Office Ally Office Ally Clearinghouse		Phase I Phase II
OptumInsight Optum Netwerkes v2.2.0		Phase I Phase II
OptumInsight Optum Transaction Exchange v2.0.1 & v2.2.0		Phase I Phase II
Passport Health Communications OneSource		Phase I Phase II
Post-N-Track Doohickey™ Web Services		Phase I Phase II
Practice Insight EDIinsight		Phase I
RealMed Corporation RealMed Revenue Cycle Management		Phase I
RelayHealth RelayExchange™		Phase I Phase II
SecureEDI/Immediata SecureEDI Clearinghouse		Phase I
Siemens/HDX Healthcare Data Exchange		Phase I Phase II
Smart Data Solutions Smart Data Stream Clearinghouse		Phase I Phase II
Surescripts Surescripts Prescription Benefit		Phase I
TransUnion Healthcare, LLC MedConnect		Phase I
The SSI Group, Inc ClickON E-Verify Suite		Phase I Phase II
Xerox ACS EDI Direct		Phase I Phase II
ZirMed Real Time Eligibility		Phase I

Vendors

Organization Product		Certified Phase(s) (Committed Phase(s))
athenahealth athenaCollector		Phase I Phase II
CSC CSC DirectConnect®		Phase I (Phase II: Q2 2013)
EmergingHealth TREKS		Phase I
eServices Group, Inc. XJ Series Gateway Services		Phase I Phase II
GE Healthcare Centricity Business Version 4.0 and Version 4.3		Phase I
GE Healthcare Centricity Business Version 5.0 Eligibility/Benefits		Phase I Phase II
GE Healthcare Centricity Business Version 5.0 Claim Status		(Phase I & II: Committed)
HealthTrio, LLC connect		Phase I Phase II
IVANS EligibilityOne		(Phase I: Q3 2013)
Loxogon Loxogon Alloy™		Phase I
Medical Informatics Engineering WebChart EMR		Phase I
Medical Present Value, Inc. (MPV) MPV Eligibility		Phase I
NextGen Healthcare NextGen® Practice Management (Small & Group Practices)		Phase I Phase II
NoMoreClipboard.com NoMoreClipboard.com		Phase I
Recondo Technology Eligibility Plus		(Phase I & II: Q2 2013)
Recondo Technology SurePayHealth		Phase I Phase II
RelayHealth Payor Connectivity Services (PCS)		Phase I Phase II
RelayHealth RelayClearance™ Plus		Phase I (Phase II: Committed)
The SSI Group Inc ClickON E-Verify Suite		Phase I Phase II
VisionShare Secure Exchange Software Interactive		Phase I (Phase II: Q2 2013)

*Indicates a WellPoint company

CORE Health Plan IT Exemptions & Out of Scope Designations:

Exemptions: The CAQH CORE Exemption Policy allows a health plan seeking voluntary CORE Certification to request that a scheduled migration of an existing IT system(s) or recent mergers at the time of CORE Certification be exempt from CAQH CORE Conformance. Health plan exemptions will be granted only if:

• The exempted system affects less than 30% of the health plan’s membership and
• The remainder of the health plan's IT systems is in conformance with all applicable CAQH CORE Operating Rule requirements.
• A documented plan is in place for the exempted IT system(s) to be brought into conformance with the CAQH CORE Operating Rules.

The CAQH CORE Exemption Policy requires that within 12 months of the health plan's CORE Certification all exempt systems must be remediated to operate in conformance with the applicable CAQH CORE Operating Rules.

Out of Scope Designations: Out of Scope Designations are applied when claims are fully owned and processed by another organization and, therefore, the CAQH CORE Operating Rules cannot be applied by the certifying health plan (i.e., member data for the product is wholly owned by the external organization). If a health plan touches the administrative data but outsources some processing to a Business Associate(s), an Out of Scope Designation does not apply.

Exemptions & Out of Scope Designations for CORE-certified Health Plans

System Exemptions:

¹ UnitedHealth Group (UHG): United Healthcare Community Plan, a UHG subsidiary, will be migrated to a platform that is Phase I and II CORE-certified by Q4 2013. This product covers less than 30% of UHG's membership.

Out of Scope Designations:

² Humana: Humana Military Healthcare Services (HMHS) and Humana Puerto Rico, covering approximately 30% of Humana's membership, are out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules. HMHS claims are owned and processed by PGBA of South Carolina and, as a non-US product, Humana Puerto Rico is not covered by the CAQH CORE Operating Rules.

³ UnitedHealthGroup: OptumRx (formerly Prescription Solutions, Inc.) is out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules; claims are wholly owned and processed by OptumRx.

⁴ Blue Cross Blue Shield of Nebraska (BCBS NE): BCBS NE's Medicare Advantage and Vision products, covering less than 10% of BCBS NE's membership, are out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules. Claims for these products are owned and processed by ClearStone Solutions (for Medicare Advantage) and VSP and Davis Vision (for Vision product).

⁵ Rocky Mountain Health Plans (RMHP): RMHP's non-medical Dental and Vision products, covering less than 10% of RMHP's membership, are out of scope for the CAQH CORE Eligibility & Claim Status Operating Rules. Claims for these products are owned and processed by Delta Dental (for Dental product) and VSP (for Vision product).