Claredi Core Certification Testing Features

Verify with confidence and efficiency

Testing and certifying against the CORE Phase I rules allow payers to help providers verify 1) whether a health plan covers the patient, 2) whether certain services are covered by the health plan, and 3) the patient’s co-pay, coinsurance, and base deductible amounts (as defined in the member contract). In addition, the rules establish policies governing the exchange of that data, including:
•  System connectivity
•  Standard inquiry acknowledgements
•  Maximum response times
•  Minimum hours a system must be available
•  Standard 270/271 companion guide flow and format