CORE-certified Organizations (Pending and Current) | CAQH

CORE-certified Organizations (Pending and Current) | CAQH
CORE
CORE Participation
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CORE
CORE Certification
CORE-certified Organizations (Pending and Current)
CORE-Certified Organizations/Products
CAQH CORE certifies providers, health plans, clearinghouses, and vendors that use the healthcare transactions addressed by the CAQH CORE Operating Rules. CORE Certification means an entity's IT system or product conforms with the operating rules for a specific business process.
Endorser organizations who receive the seal support the goals of the initiative and bring value to their members, customers, clients and patients through their knowledge of and commitment to efficient healthcare data exchange.
HEALTH PLANS
PROVIDERS
CLEARINGHOUSES
ENDORSERS
VENDORS
Organization
Certified RULE SETS
Certification Status
Aetna, Inc
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals (Infrastructure Only)
Health Care Claims
Active
Active
Active
Active
Active
Alabama Medicaid Agency
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Alaska Department of Health and Social Services
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
All Savers Insurance
Eligibility & Benefits
Claim Status
Active
Active
American Postal Workers Union Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Anthem
Eligibility & Benefits
Claim Status
Active
Active
Anthem Colorado*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Connecticut*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Indiana*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Kentucky*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Maine*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Nevada*
Eligibility & Benefits
Claim Status
Active
Active
Anthem New Hampshire*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Ohio*
Eligibility & Benefits
Claim Status
Active
Active
Anthem Virginia*
Eligibility & Benefits
Claim Status
Active
Active
AultCare
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Blue Cross Blue Shield of California*
Eligibility & Benefits
Claim Status
Active
Active
Blue Cross Blue Shield of Georgia*
Eligibility & Benefits
Claim Status
Active
Active
Blue Cross Blue Shield of Missouri*
Eligibility & Benefits
Claim Status
Active
Active
Blue Cross Blue Shield of Nebraska*
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Blue Cross Blue Shield North Carolina*
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Blue Cross Blue Shield of Tennessee*
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Blue Cross Blue Shield of Wisconsin*
Eligibility & Benefits
Claim Status
Active
Active
CalOptima
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
CareSource
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Centene Corporation
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Cigna
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Contra Costa Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Delta Dental of California
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental of Delaware
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental District of Columbia
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental Insurance Company
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental of New Your
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental of Pennsylvania
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental of Puerto Rico
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
^Delta Dental of West Virginia
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Dentegra
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Empire Blue Cross Blue Shield*
Eligibility & Benefits
Claim Status
Active
Active
Excellus Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Golden Rule Insurance Company
Eligibility & Benefits
Claim Status
Active
Active
Harvard Pilgrim Health Care
Eligibility & Benefits
Claim Status
Active
Active
Health Net
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Horizon Blue Cross Blue Shield of New Jersey
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Humana
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals (Infrastructure Only)
Health Care Claims
Benefit Enrollment
Premium Payment
Active
Active
Active
Active
Active
Active
Active
Inland Empire Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Kaiser Permanente Colorado
Eligibility & Benefits
Claim Status
Active
Active
Kaiser Permanente Washington
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Medical Mutual of Ohio
Eligibility & Benefits
Claim Status
Active
Active
MVP Health Care
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
National Association of Letter Carriers Health Benefit Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
New Hampshire Medicaid
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
North Dakota Health & Human Services
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Palmetto GBA
Payment & Remittance
Active
Partnership Health Plan
Eligibility & Benefits
Claim Status
Active
Active
PrimeWest Health
Eligibility & Benefits
Claim Status
Active
Active
Sanford Health Plan
Eligibility & Benefits
Claim Status
Active
Active
Security Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Sutter Health Plus
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Texas Medicaid
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals (Infrastructure only)
Health Care Claims
Active
Active
Active
Active
Active
Trillium Community Health Plan
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Tufts Health Plan
Eligibility & Benefits
Claim Status
Active
Active
United Healthcare Life Insurance Company
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
United Health Group
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Organization
CERTIFIED RULE SETS
CERTIFICATION STATUS
U.S Department of Veterans Affairs
Eligibility & Benefits
Active
Organization Product
CERTIFIED RULE SETS
CERTIFICATION STATUS
Ability
CHOICE All-Payer Claims
Eligibility & Benefits
Active
Alight Solutions, LLC
Connections Eligibility EDI 834 5010 File
Benefit Enrollment
Active
ASSERTUS
ASSERTUS Clearinghouse
Eligibility & Benefits
Claim Status
Active
Active
Availity, LLC
Availity Health Information Network
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals (Infrastructure only)
Health Care Claims
Active
Active
Active
Active
Active
Claim.MD
Claim.MD
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Conduent EDI Solutions, Inc.
Conduent EDI Direct
Eligibility & Benefits
Claim Status
Active
Active
Eligible
Eligible
Eligibility & Benefits
Claim Status
Payment & Remittance
Health Care Claims
Active
Active
Active
Active
eMEDIX
eMEIDIX Clearinghouse Eligibility
Eligibility & Benefits
Claim Status
Active
Active
eProvider Solutions
eProvider Solutions
Eligibility & Benefits
Claim Status
Active
Active
Experian Health
OneSource
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
FinThrive, Inc.
Insurance Clearinghouse
Eligibility & Benefits
Claim Status
Active
Active
GE Healthcare
Centricity EDI Clearinghouse
Eligibility & Benefits
Claim Status
Active
Active
HEALTHeLink
HEALTHeNET
Eligibility & Benefits
Claim Status
Active
Active
HFMI LLC
maxRTE
Eligibility & Benefits
Active
HMS
HMS
Eligibility & Benefits
Active
Inmediata Health Group Corp.
Inmediata Clearinghouse
Eligibility & Benefits
Claim Status
Active
Active
InstaMed
InstaMed Network
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
NaviNet
NaviNet
Eligibility & Benefits
Claim Status
Active
Active
Office Ally
Clearinghouse
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Optum Insight
Medical Network
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Oracle Health
HDXTS
Eligibility & Benefits
Active
Pay Span
PaySpanHealth.com
Payment & Remittance
Active
PNT Data
EDI Services & Clinical Data Services
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
pVerify
pVerify
Eligibility & Benefits
Claim Status
Active
Active
RealMed Corporation
RealMed Revenue Cycle Management
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Retrace
Clearinghouse+
Eligibility & Benefits
Claim Status
Payment & Remittance
Health Care Claims
Active
Active
Active
Active
Smart Data Solutions
Smart Data Stream Clearinghouse
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
Stedi
Stedi
Eligibility & Benefits
Active
The SSI Group, Inc
Access Director V 3.5
Prior Authorization & Referrals (Infrastructure only)
Active
The SSI Group, Inc
ClickON E-Verify Suite
Eligibility & Benefits
Claim Status
Active
Active
The SSI Group, Inc
ClickON Remittance Module
Payment & Remittance
Active
TriZetto Provider Solutions
Integrated Eligibility & Integrated Claim Status Inquiry
Eligibility & Benefits
Claim Status
Active
Active
TriZetto Provider Solutions
CORE III version 2
Payment & Remittance
Active
UHIN
uTRANSEND v2.0
Eligibility & Benefits
Claim Status
Payment & Remittance
Pending
Pending
Pending
National Electronic Attachment, Inc.
Vyne Dental Clearinghouse Services
Eligibility & Benefits
Active
ORGANIZATION
RULE SETS
Accenture
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
American Academy of Family Physicians
Eligibility & Benefits
Claim Status
American Association of Preferred Provider Organizations
Eligibility & Benefits
American College of Physicians
Eligibility & Benefits
American Health Information Management Association
Eligibility & Benefits
American Medical Association
Claim Status
Calpion
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
CalRHIO
Eligibility & Benefits
CamCare
Eligibility & Benefits
Center for Health Transformation
Eligibility & Benefits
Claim Status
Claredi
Eligibility & Benefits
Cognizant
Eligibility & Benefits
Claim Status
Cognosante
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
Edifecs, Inc.
Eligibility & Benefits
eHealth Initiative
Eligibility & Benefits
EHNAC
Eligibility & Benefits
emids Technologies
Eligibility & Benefits
Claim Status
Payment & Remittance
Enclarity, Inc.
Eligibility & Benefits
FISGlobal
Eligibility & Benefits
Claim Status
Foresight Corporation
Eligibility & Benefits
Claim Status
Greater New York Hospital Association
Eligibility & Benefits
Healthcare Financial Management Association
Eligibility & Benefits
Healthcare Information and Management Systems Society
Eligibility & Benefits
HIPAA QA, Inc.
Eligibility & Benefits
Claim Status
IRIS Health Services
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
IRIS Technologies
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
Links2Success
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
Methodical
Eligibility & Benefits
Claim Status
Medical Group Management Association
Eligibility & Benefits
Claim Status
Medical Practice Software, Inc.
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
Michigan Public Health Institute
Eligibility & Benefits
Microsoft
Eligibility & Benefits
MultiPlan
Eligibility & Benefits
Musculoskeletal Imaging Consultants LLC
Eligibility & Benefits
Claim Status
NACHA
Eligibility & Benefits
Claim Status
Pillsbury Winthrop Shaw Pittman, LLP
Eligibility & Benefits
Qualedix
Eligibility & Benefits
Claim Status
Smart Card Alliance
Eligibility & Benefits
Claim Status
SCG Health
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
SunCoast RHIO
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals
Health Care Claims
Benefit Enrollment
Premium Payment
URAC
Eligibility & Benefits
Virtusa
Prior Authorization & Referrals
WEDI
Eligibility & Benefits
Data Dimensions
Eligibility & Benefits
Claim Status
athenahealth
athenaCollector
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
CVS Health
Pharmacy Benefit Management Division
Payment & Remittance
Active
SS&C Health
SS&C Health
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
ECHO Health, Inc.
National EFT/ERA Simplicity Payment Solution v8.1
Payment & Remittance
Active
Mphasis
HEALTHpac
Eligibility & Benefits
Claim Status
Active
Active
Mphasis
Javelina
Eligibility & Benefits
Claim Status
Active
Active
FrontRunnerHC
FrontRunnerHC
Eligibility & Benefits
Claim Status
Active
Active
GE Healthcare
Centricity Business Version 4.0 and Version 4.3
Eligibility & Benefits
Active
GE Healthcare
Centricity Business Version 5.0 Eligibility/Benefits
Eligibility & Benefits
Claim Status
Active
Active
GE Healthcare
Financial Risk Manager Version 6.1
Eligibility & Benefits
Claim Status
Payment & Remittance
Active
Active
Active
HealthTrio
Smart Series
Eligibility & Benefits
Claim Status
Payment & Remittance
Prior Authorization & Referrals (Infrastructure Only)
Health Care Claims
Benefit Enrollment
Active
Active
Active
Active
Active
Active
Intellisight Technology, Inc.
FieldWorker
Health Care Claims
Prior Authorization & Referrals
Active
Active
Medical Present Value, Inc. (MPV)
MPV Eligibility
Eligibility & Benefits
Active
NextGen Healthcare
NextGen® Practice Management
(Small & Group Practices)
Eligibility & Benefits
Claim Status
Active
Revenue Management Solutions, LLC (RMS)
Payment & Remittance
Active
The SSI Group Inc
ClickON E-Verify Suite
Eligibility & Benefits
Claim Status
Active
Active
Veuu Incorporated
payVeuu
Payment & Remittance
Active
XIFIN
XIFIN RPM
Eligibility & Benefits
Claim Status
Active
Active
Zelis™ Payments
Zelis ACH
Payment & Remittance
Active
*Indicates an Anthem, Inc. company
^Indicates affiliates to Delta Dental of California
CORE Health Plan IT Exemptions & Out of Scope Designations:
System Exemptions:
Cigna: System migrations are underway to ensure the following Cigna products run over Payment & Remittance CORE-certified platforms:
Qualcare and Qualcare Delivery System Alliances
. These products cover less that 1% of Cigna's membership.
Out of Scope Designations:
Humana:
Humana Military Healthcare Services
(HMHS) and
Humana Puerto Rico
, covering approximately 30% of Humana's membership, are out of scope for the Eligibility & Benefits, Claim Status, and Payment & Remittance CAQH CORE 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.
UnitedHealth Group:
OptumRx
(formerly
Prescription Solutions, Inc.
) is out of scope for the CAQH CORE Eligibility & Benefits and Claim Status Operating Rules; claims are wholly owned and processed by
OptumRx
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 Operating Rules. Claims for these products are owned and processed by ClearStone Solutions (for
Medicare Advantage
) and VSP and Davis Vision (for Vision product).
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 & Benefits and Claim Status Operating Rules. Claims for these products are owned and processed by Delta Dental (for Dental product) and VSP (for Vision product).