To get started in setting up your CAQH account, you can click here.


When you are updating your information, if an insurance that you work with DOES NOT link with CAQH, you must keep that information up to date with them individually.  For all insurances below, CAQH will update your information with the designated carrier.



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 AgencyAlabama Medicaid A
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Alameda Alliance for Health 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Alaska Department of
Health and Social Services
Alaska Logo
  • 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
AvMed Health Plans
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Blue Cross 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 Nebraska3
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield of North Carolina
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
BlueCross BlueShield of Tennessee
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Blue Cross Blue Shield of Wisconsin*
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Boston Medical Center Health Plan      
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
CalOptima 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Centene Corporation
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Cigna7
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
ConnectiCare
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Contra Costa Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
County of Riverside - Exclusive Care
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
DAKOTACARE
  • 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 York 
  • 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
EmblemHealth
  • 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
First Medical Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
 
Florida Division of Medicaid

  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Georgia Department of Community Health
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Gold Coast Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Golden Rule Insurance Company
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Government Employees Health AssociationGEHA Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
 
Harvard Pilgrim Health Care
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Health Plan of San Joaquin 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Health Plan of San Mateo 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Health NetHealth Net
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Healthplex 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Horizon Blue Cross Blue Shield of New Jersey
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Humana1
  • 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
MaineCare
 

  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Medical Card Systems 
  • Eligibility & Benefits
  • Active
Medical Mutual of Ohio
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance (Q4 2020)
  • Active
  • Active
  • Pending
MVP Health CareMVP Healthcare
  • 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
Nebraska Medicaid
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
New Hampshire Medicaid 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
North Dakota Department of Human Services 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Oklahoma Office of Management and
Enterprise Services: Employees Group
Insurance Division
 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Partnership Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance (Q4 2020)
  • Active
  • Active
  • Pending
Physicians Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
PrimeWest Health
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Priority Health 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Providence Health PlanProvidence Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance (Q4 2020)
  • Active
  • Active
  • Pending
Public Employees Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Rocky Mountain Health Plans4
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Sanford Health Plan 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
San Francisco Health Plan
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Santa Clara Family Health Plan 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Security Health PlanSecurity Health Plan Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
SummaCare
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Sutter Health PlusSutter 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 Commmunity Health Plan 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Triple-S Salud 
BlueCross BlueShield of Puerto Rico
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
 
Tufts Health Plan
 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
UnitedHealthcare Life Insurance Company
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
UnitedHealth Group2
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
University of Pittsburgh Medical Center
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Mayo Clinic
  • Eligibility & Benefits
  • Active
Montefiore Medical Center
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Quest Diagnostics 
  • Eligibility & Benefits
  • Active
Summit Medical Group
  • Eligibility & Benefits
  • Active
U.S. Department of Veterans Affairs
  • Eligibility & Benefits
  • Active
Wake Forest University Health Sciences
  • Eligibility & Benefits
  • Active


Clearinghouses


Ability
CHOICE All-Payer Claims

  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
AdminisTEP, LLC
AdminisTEP Next Generation Clearinghouse including Eligibility and Claim Status
 
  • 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
Avizzor Health Solutions
Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Capario
Phoenix Processing System
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Cerner/Healthcare Data Exchange
HDX		 
  • Eligibility & Benefits
  • Active
 
Change Healthcare
Real Time and Batch Transaction Processing and Data Hosting Service
RelayExchangeTM
Change Healthcare Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Change Healthcare
Remittance and Payment Management
Change Healthcare Logo
  • Payment & Remittance
  • Active
Claim.MD
Claim.MD		 
  • Eligibility & Benefits
  • Active
ClaimRemedi
ClaimRemedi by eSolutions
 
ClaimRemedi Logo
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Conduent EDI Solutions, Inc.
Conduent EDI Direct
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Dorado Systems
doradoConnect by eSolutions
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Dorado Systems
doradoVerify
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Eligible
Eligible		Eligible Logo
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
eMEDIX
eMEDIX Clearinghouse Eligibility
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active

eProvider Solutions
eProvider Solutions

eProvider Solutions
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
eServices Group Inc.
Unite
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Experian Health
OneSource
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
GE Healthcare
Centricity EDI Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Healthcare IP
Healthcare IP		 
  • Eligibility & Benefits
  • Active
HEALTHeLink
HEALTHeNET
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
HeW
Revenue Cycle Management & EDI Services
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
HealthFusion
HealthFusion® Real-Time
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
HMS
HMS
  • Eligibility & Benefits
  • Active
InstaMed
InstaMed Network
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
MD On-Line, Inc.
ACCE$$ Patient Eligibility Verification
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active

GMG Management Consulting, Inc.
GMG Management Consulting, Inc.

 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
NaviNet
NaviNet		/sites/default/files/NaviNet%20Logo%20Large.png
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Navicure
Eligibility
 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Office Ally
Office Ally Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Optum
Optum360
  • Payment & Remittance
  • Active
OptumInsight
Optum Netwerkes
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
OptumInsight
Optum Transaction Exchange
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Pay Span
PaySpanHealth.com
 
  • Payment & Remittance
  • Active
PNT Data
EDI Services & Clinical Data Services
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
PokitDok
PokitDok Platform
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Prior Authorization & Referrals (Infrastructure only)
  • Health Care Claims
  • Active
  • Active
  • Active
  • Active
  • Active
Practice Insight
EDIinsight by eSolutions
 
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
RealMed Corporation
RealMed Revenue Cycle Management
 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Retrace Labs, Inc.
Retrace Labs		 
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Inmediata Health Group Corp.
Inmediata Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
Smart Data Solutions
Smart Data Stream Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Active
  • Active
  • Active
Surescripts
Surescripts Prescription Benefit
  • Eligibility & Benefits
  • Active
TransUnion Healthcare, LLC
Insurance Clearinghouse
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
The SSI Group, Inc
Access Director V 3.5		SSI Group
  • Prior Authorization & Referrals (Infrastructure only)
  • Active
The SSI Group, Inc
ClickON E-Verify Suite		SSI Group
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
The SSI Group, Inc
ClickON Remittance Module		SSI Group
  • Payment & Remittance
  • Active
TriZetto Provider Solutions
Integrated Eligibility & Integrated Claim Status Inquiry		Trizetto III
  • Eligibility & Benefits
  • Claim Status
  • Active
  • Active
TriZetto Provider Solutions
CORE III version 2		Trizetto III
  • Payment & Remittance
  • Active
UHIN
uTRANSEND v2.0
 

 

  • Eligibility & Benefits
  • Claim Status
  • Payment & Remittance
  • Pending
  • Pending
  • Pending
Waystar
Claims Management
  • Payment & Remittance
  • Active
WorkCompEDI
Clearinghouse 
  • Payment & Remittance
  • Health Care Claims
  • Active
ZirMed
Eligibility Verification
  • Eligibility & Benefits
  • Active