Operating Rules
Test & Certify

Edifecs Certification Testing portal is a free industry service enabling health plans, providers, vendors and clearinghouses to successfully complete all test cases recommended by CAQH CORE. Edifecs has helped over 190 organizations obtain CORE certification. Edifecs can expedite the certification process and maintain on-going compliance with our industry leading services.

CORE Phase I, II, III Testing System

Portal Access

Which CORE Stakeholder are you?


Provider

Providers are those physicians, physician groups, and hospitals who need to determine the eligibility or request claim status information of a patient. (HIPAA 270/276 transactions)


Vendor

A vendor is an organization that provides practice management, eligibility-specific, or claim status-specific information systems to providers, hospitals or other patient care professionals. (HIPAA 270/276 transactions)


Payer

A health plan is a Payer organization with members who are serviced by the provider community or respond to eligibility requests. (HIPAA 271/277 transactions)


Clearinghouse

As a CORE stakeholder, Clearinghouses can have many roles in eligibility process and are given three options. (Submit request only, receive request only, submit and receive) 

4 Step Process

The CORE certification process has four components. Each component has multiple steps that must be completed before moving on to the next. This enables our tester to execute compliance goals in a phased manner. Edifecs’ technical and business subject matter expertise are available to help participants overcome issues or challenges during any part of the process.

Step 2 – Sign & Submit CORE Pledge

As a CORE stakeholder, Clearinghouses can have many roles in eligibility process and are given three options. (Submit request only, receive request only, submit and receive)

Step 1 – Pre-Certification Process

Leveraging over eight years of experience in CORE certification, we have developed a simple four step process to help participants achieve compliance in a phased and planned manner. We provide a self-guided certification process and comprehensive services to help expedite certification process. We offer a simple self-registration to start the process.

Step 3 – Certification Testing

All the various testing programs and tasks associated with demonstrating implementation of all applicable CORE rules are available in the Edifecs CORE Certification System. The programs have been designed to work in the numerical order of the CORE rules and satisfy all of the CORE test scripts.

Step 4 – Apply for your CORE seal

Overcoming challenges in your journey

Having helped many organizations get CORE certified and as a trusted partner, we fully understand the concerns and challenges of testing. The process can be confusing and roadblocks with internal systems are common. Edifecs offers a host of solutions and services options for overcoming challenges with internal systems, setting up connectivity, creating master test data, understanding rules or policies or mitigating resource constraints for testing.

Edifecs Compliances Solution 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.

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Solutions and Services Spotlight

  • Certification Assessment Service Offering

    Edifecs can help you assess your readiness for CAQH CORE Phase I, II and III compliance across people, process & technology. The process involves conducting workshops with key stakeholders, identifying gaps and providing recommendations, documenting next steps and a creating a roadmap to remediate the gaps.

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  • Extended Testing Service

    Edifecs offers varied test scenarios and load conditions in its Testing Service offering. Configurable and scalable HIPAA and CORE validation with out-of-the box transaction workflows for testing Operating Rules Phases I – III transactions as well as CORE compliant connectivity.

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  • Certification Assistance Services

    Edifecs experts can assist health plans, providers, clearinghouses or a vendors to expedite the certification testing process with our dedicated functional and technical subject matter expertise. We offer many types and sizes of engagement to accommodate any testing support needs.

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  • Edifecs Ongoing Monitoring

    Available by phase, transaction, via the cloud or on premise, Edifecs Ongoing Monitoring solution provides continual surveillance and documentation of the Certification testing process. The solution connects trading partners using both batch and real-time connectivity and sends alerts when service levels are at risk – prompting investigation and action that ensures ongoing compliance is maintained.

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  • Edifecs Operating Rule Foundation Module

    Operating Rules span a wide range of technical and business centric requirements for successful implementation and compliance. Edifecs bundles these capabilities into one comprehensive solution with product configuration built-in to meet specific testing requirements.

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