CAQH certifies and awards CORE Certification Seals to entities that create, transmit or use the administrative transactions addressed by applicable Operating Rules. CORE Certification means an entity has demonstrated that its IT system or product is operating in conformance with a specific phase(s) of the Operating Rules.
Change Healthcare is CAQH CORE certified for the federally mandated operating rules supporting the Eligibility & Benefits, Claim Status, and Payment & Remittance transactions demonstrating that our associated IT systems and products are operating in conformance with effective standards and operating rules.
The CAQH link to our certification status can be found at http://www.caqh.org/core/core-certified-organizations-pending-and-current within the Clearinghouses and Vendors tabs.
Additional information regarding the Operating Rules for HIPAA transactions can be found on the Change Healthcare HIPAASimplified.com website.
Change Healthcare is EHNAC HNAP-EHN and ePAP-EHN accredited.
The Electronic Healthcare Network Accreditation Commission (EHNAC) is a federally recognized standards development organization and tax-exempt, 501(c)(6) non-profit accrediting body designed to improve transactional quality, operational efficiency, and data security in healthcare.
EHNAC indicates the following compliance benefits associated with accreditation:
- Reduce risk to PHI and operations through the demonstration of a risk management program with effective controls that appropriately minimize threats.
- Prepare organizations for third party audits including 21st Century Cures Act; HIPAA/HITECH compliance audits that are now being conducted for the Office of Civil Rights (OCR); trading partner audits; and state compliance (EHNAC accreditation is required for processing healthcare transactions in the states of Maryland and New Jersey).
- Enhance trust for customers, trading partners, and other stakeholders.
EHNAC’s Healthcare Network Accreditation Program (HNAP) Electronic Health Network (EHN) assessment and review covers five main categories of criteria:
- Privacy and confidentiality criteria include policies for securing PHI, system access controls, role-based user authentication and other related measures.
- Technical performance criteria include transaction monitoring and processing capacity, response timeliness and accuracy, system availability, use of industry standard data formats and other infrastructure practices.
- Business practices criteria include policies, procedures, and contract standards to assure truth in advertising, ongoing customer satisfaction measurement, customer service and training, and other related measures.
- Physical, human, and administrative resources criteria include the organizational ability to sustain levels of service, maintain escalation procedures, and invest in professional development and other capabilities.
- Security criteria include facility access, disaster recovery, business continuity, organizational safeguards, audit trails and other practices.
EHNAC requires that organizations complete the program every two years to maintain accreditation which includes a detailed criteria-based assessment and EHNAC audit and site reviews. Change Healthcare has maintained our EHNAC Electronic Health Network accreditation since 2001.
Change Healthcare Certificates of Accreditation:
Change Healthcare has earned HITRUST certification status for its enterprise infrastructure and Change Healthcare Platform. The certification covers hosting services, end user and internal support services, infrastructure and physical and environmental controls. The scope of the certification includes both its on-premises data centers and its Intelligent Cloud Platform operating in its AWS, Azure and Google Cloud environments.
HITRUST Risk-based, 2-year (r2) Certified status demonstrates that the organization’s major implemented systems and platforms have met key regulations and industry-defined requirements and is appropriately managing risk. This achievement places Change Healthcare in an elite group of organizations worldwide that have earned this certification. By including federal and state regulations, standards, and frameworks, and incorporating a risk-based approach, the HITRUST Assurance Program helps organizations address security and data protection challenges through a comprehensive and flexible framework of prescriptive and scalable security controls.
HHS Administrative Simplification Optimization Program
As a trusted industry leader and in support of our commitment to compliance, Change Healthcare volunteered and was selected to participate in the U.S. Department of Health & Human Services (HHS) Administrative Simplification Optimization Program pilot. The program comprises a formal assessment by the National Standards Group (NSG) within the Centers for Medicare & Medicaid Services (CMS), to review compliance with federally mandated transaction standards, code sets, unique identifiers, and operating rules.
Change Healthcare is one of the first organizations certified by the NSG demonstrating that our Medical, Hospital, and Dental Exchange batch and real-time services and solutions have been reviewed for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification regulations and Affordable Care Act (ACA) Operating Rule provisions.
Change Healthcare is a Maryland Healthcare Commission (MHCC) certified Electronic Health Network (EHN).
The Maryland Health Care Commission is an independent regulatory agency whose mission is to plan for health system needs, promote informed decision-making, increase accountability, and improve access in a rapidly changing health care environment by providing timely and accurate information on availability, cost, and quality of services to policy makers, purchasers, providers and the public.
The Maryland Health Care Commission certifies Electronic Healthcare Networks that meet national standards for security, business processes, technical performance, privacy and confidentiality when transmitting patient health information. As part of the evaluation process, MHCC reviews an EHN’s national accreditation site audit and recommends areas where enhancements would help reduce risks of exposure to data breaches.
Maryland Regulation 10.25.07, Certification of Electronic Health Networks and Medical Care Electronic Claims Clearinghouses, requires third party payers that accept electronic health care transactions originating in Maryland to accept electronic health care transactions only from MHCC certified EHNs. MHCC-EHN certification demonstrates that Change Healthcare meets a number of national and local standards intended to ensure high quality business operations and the existence of sound privacy and security policies. MHCC certification represents to other networks, payers, and providers that Change Healthcare meets a reasonable level of quality and technical performance.
MHCC requires that EHN’s complete the evaluation process every two years to maintain certification.
The National Committee for Quality Assurance (NCQA) is a private, 501(c)(3) not-for-profit organization dedicated to improving health care quality by assessing and reporting on the quality of health-related programs. NCQA certification is a reliable indicator that an organization is well-managed and demonstrates the organization's commitment to meeting and maintaining industry developed quality standards.
NCQA's Healthcare Effectiveness Data and Information Set (HEDIS) Measure Certification is precise, automated testing that verifies compliance with HEDIS Specifications and satisfies the source code review portion of the HEDIS Compliance Audit™. Since its introduction in 1993, HEDIS has evolved to become the gold standard in managed care performance measurement. Change Healthcare has been providing certified HEDIS reporting solutions since 1997.
- For each consecutive year since 2005, Change Healthcare's Quality Performance Advisor™ solution has been NCQA HEDIS Measures Certified in all measures. Quality Performance Advisor™ also received NCQA certification for the California Value Based Pay for Performance (VBPP) program. This statewide initiative is one of the largest alternative payment models in the United States.
- Change Healthcare’s Compliance Reporter™ solution has been NCQA HEDIS Measures Certified every year since 2012. Compliance Reporter™ also supports Quality Assurance Reporting Requirements (QARR) measures as required in the state of New York.
Change Healthcare's Quality Performance Advisor™ and Compliance Reporter™ solutions power a suite of web-based HEDIS offerings, including certified rate reporting and analytics, hybrid medical record reviews, and customizable reporting across measures, enabling health plans to effectively manage and optimize HEDIS processes, reporting, submission, and results.
NCQA's Physician and Hospital Directories certification validates quality measures for online solutions which help eligible individuals choose physicians and hospitals. Change Healthcare's Provider Directory solution has been NCQA Health Information Product Physician and Hospital Directories (HIP4) Certified in all measures. Change Healthcare's Provider Directory solution helps members easily search and compare doctors, specialists, hospitals, imaging centers and more in a user-friendly interface. Combined with our cost transparency solution, Provider Directory empowers members to take a more active role in their health, guiding them to make smarter decisions for healthier outcomes.
The following Change Healthcare solutions are Payment Card Industry Data Security Standard (PCI DSS) certified:
SmartPay™ Consumer Pay Online
SmartPay™ Consumer Lockbox
SmartPay™ Phone Pay
This annual certification verifies that these Change Healthcare solutions have passed the rigorous standards promulgated by the PCI DSS.
The PCI DSS is a set of security requirements created by an association of credit card brands, including VISA, MasterCard and American Express intended to protect cardholder data (credit card data). The steady increase in electronic payment options available makes it extremely important to protect customers’ personal information. You can learn more about the PCI DSS and the standards it requires at www.pcisecuritystandards.org/security_standards.
Change Healthcare abides by all applicable PCI DSS requirements under which we secure any and all cardholder data that we store, process or transmit for our customers. This notification is part of the certification process.
Keeping our customers’ information secure is a top priority for Change Healthcare. We dedicate extensive resources to make sure personal medical and financial information is secure and we strive to build a company culture that reinforces trust at every opportunity.
We appreciate your continued partnership. If you have any questions about the Change Healthcare PCI Compliance efforts or the measures we’re taking to keep your data safe, please contact your account representative or the Security Compliance Team.