Providers (HIPAA 270/276 Transactions)
Physicians, physician groups, clinic systems, and hospitals who need to determine the eligibility or request claim status information on a patient.
Vendors (HIPAA 270/276 Transactions)
Organizations that provide practice management, eligibility-specific, or claim status-specific information systems to providers, hospitals, or other patient-care professionals.
Health Plans (HIPAA 271/277 Transactions)
Organizations who have members serviced by the provider community or need to respond to eligibility requests.
Clearinghouses
Clearinghouses can have many roles in the eligibility process and are given three options: submit request only, receive request only, and submit and receive requests.
How Do I Become a CORE Stakeholder?
The CORE certification process has four steps. Each step has action items that must be completed before moving to the next step. This enables our tester to execute compliance goals in a phased manner. Edifecs technical and business subject matter experts are available to help companies through the certification process.
Pre-Certification Process
Sign and Submit CORE Pledge
Certification Testing
Apply for CORE Seal
Services
Certification Assessment
Assess your readiness for CAQH CORE Phase II, III and IV compliance across people, process & technology.
Certification Assistance
Expedite the certification testing process with our dedicated functional and technical subject matter experts.
Extended Testing
Take advantage of various test scenarios and load conditions in its Testing Service offering with configurable and scalable HIPAA and CORE validation.
Edifecs Ongoing Monitoring
Ensure ongoing compliance is maintained with continual surveillance and documentation of the certification testing process.
Edifecs Operating Rules Foundation Module
Meet specific testing requirements with built-in product configuration for successful implementation.
Support
Test & Certify with Edifecs Certification Testing Portal
This free service enables health plans, providers, vendors, and clearinghouses to successfully complete all test cases recommended by CAQH CORE. We’ve helped over 190 organizations obtain CORE certification, expedite the certification process, and maintain on-going compliance with our industry leading services. CORE Phase I, II, III, & IV Testing System
Achieve & Maintain CORE Compliance with Edifecs Compliance Solutions and Services
Edifecs provides a full range of services and software solutions for customers to achieve and maintain CORE Compliance, including identifying gaps and building a remediation roadmap to bridge them. Edifecs also offers subject matter expertise and services to expedite the certification process.