Medicaid can save more than $4.8 billion by moving to fully electronic transactions

WASHINGTON, Aug. 13, 2018 /PRNewswire/ — CAQH CORE® today announced that state agencies and health plans covering 44 percent of all Medicaid enrollees have achieved some level of CORE Certification. This compares to 78 percent for commercial health plans and 75 percent for Medicare Advantage plans. Medicaid agencies and health plans can save more than $4.8 billion annually by fully adopting CAQH CORE Operating Rules for electronic transactions as verified by certification.

A collaboration of more than 130 public and private entities across the healthcare industry, CAQH CORE develops operating rules that support electronic sharing of administrative data quickly, cost-effectively and securely. There are currently four phases of operating rules, each covering a different set of administrative transactions. CORE Certification is the gold standard for demonstrating market adoption and adherence to operating rules.

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“Medicaid payers confront the challenges of administrative costs, productivity and information security through CORE Certification,” said Robin J. Thomashauer, President of CAQH. “The benefits to enrollees, taxpayers and government programs from efficient operational processes and electronic transactions are significant.”

By adopting all four phases of operating rules for electronic transactions – and verifying through CORE Certification – Medicaid payers can reduce overhead expenses and direct more state and federal tax dollars toward patient care. For example, Medicaid payers in Florida could save $177 million, Illinois could save $294 million and those in California could save $655 million annually. For an analysis of the potential savings in each state, click here.

“Provider organizations that serve a large number of Medicaid enrollees like CHRISTUS find working with CORE-certified Medicaid plans to be far more efficient and predictable,” said George Conklin, CAQH CORE Board Member and CIO, CHRISTUS Health. “We strongly urge those Medicaid plans that are not certified to contact CORE and learn about the benefits to their organizations and the people they serve.”

Read the list of CORE-certified organizations or interact with our dashboard of CORE-certified Medicaid payers.

Learn how to become CORE certified.


Medicaid Potential



Medicaid Potential



$ 5,739,000


$ 31,303,000


$ 1,329,000


$ 5,366,000


$ 124,554,000


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