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Availity Achieves CORE Certification on Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Rules
[February 08, 2024]

Availity Achieves CORE Certification on Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Rules

Availity, the nation's largest real-time health information network, announced today that it achieved the CAQH Committee on Operating Rules for Information Exchange (CORE®) Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Certification Seals.

Operating rules and underlying standards enable health plans, healthcare providers, and vendors to electronically share large quantities of administrative data quickly, cost effectively, and accurately. By specifying the business actions each party must follow in these transactions, the rules reduce costs and improve the efficiency of the nation's healthcare system.

CORE has developed the Eligibility & Benefits, Claim Status, and Payment & Remittance Operating Rules to improve electronic data exchange related to eligibility, benefits, and claim status transactions and to streamline provider payment and claim reconciliation. These operating rules establish national expectations for the flow and format of these transactions. With billions of electronic transactions conducted by the healthcare industry each year, CORE Operating Rules facilitate the seamless and secure exchange of administrative data.

CORE Certification Seals for Prior Authorization & Referrals and Health Care Claim Operating Rules confirm that Availity can exchange electronic healthcare information for eligibility, benefits and claims status, and electronic funds transfer and electronic remittance advice in conformance with the CORE Operating Rules. The CORE Certification Seals were awarded to Availity after a thorough and independent testing process and a subsequent application review. This ensures that providers can gain access to a richer set of consistent and accurate electronic administrative data.

p> "The CORE Certification Seal demonstrates Availity's leadership in the healthcare industry," said Russ Thomas, CEO of Availity. "We are committed to accelerating automation and improving interoperability across healthcare, supporting health plans, providers, and vendors with administrative and clinical solutions that drive automation and deliver insights to help improve decision-making and operational efficiencies."

The U.S. Department of Health and Human Services selected CORE to develop national operating rules for HIPAA transactions to ensure that large amounts of data can be shared electronically in a fast and efficient way. Widely viewed as the industry "gold standard," the CORE Certification Program enables organizations to demonstrate that they and their business partners have adopted and are adhering to the operating rules and their underlying standards, plus going above and beyond what is required.

"Availity is demonstrating industry leadership," said Robin J. Thomashauer, CAQH CEO. "Operating rules are most effective when everyone follows them, and today, thanks to Availity, our nation's healthcare system has taken another important step forward."

CORE is a collaboration of more than 100 participating organizations that work together to develop operating rules. Participants represent healthcare providers, health plans, vendors, associations, government entities, and the organizations that set standards for healthcare and data exchange. CORE Certification is currently available for all currently published Operating Rule Sets.

For more information, including an online demonstration, please visit or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn and Twitter.

For more information about CORE, visit

About Availity

Availity is the trusted partner for organizations seeking to realize the greatest value from clinical, administrative, and financial data. Positioned at the nexus of provider, health plan, and consumer health information, Availity develops scalable, innovative solutions for healthcare data acquisition, standardization, transparency, automation, and exchange among health plans, providers, and technology partners. As one of the nation's largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Our suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment.

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