Humana is certified by the Committee on Operating Rules for Information Exchange (CORE) and accredited by the National Committee for Quality Assurance (NCQA). With CORE certification, Humana joins others in standardizing the information insurers send to providers. NCQA standards are intended to help organizations achieve the highest level of performance possible, reduce patient risk and create an environment of continuous improvement.
CORE is an initiative by a nonprofit alliance of health plans, networks, and trade associations to simplify healthcare administration. With CORE, providers get consistent, uniform information from each insurer.
CORE’s mission is to establish operating rules that make electronic transmissions of information about patients more predictable—regardless of how they are transmitted—to:
- Improve the quality of interactions between health insurers and providers
- Encourage confidence and trust between insurers and providers
- Reduce costs
- Reduce administrative hassle
- Meet Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements and other standards
- Improve accuracy and speed in paying claims
- Encourage integration of clinical data
About NCQA accreditation
The National Committee for Quality Assurance is a private, not-for-profit organization dedicated to improving healthcare quality. NCQA strives to transform healthcare quality through measurement, transparency, and accountability.
NCQA evaluates the quality of key processes and systems that health plans provide their members. NCQA sends a team of trained healthcare experts, including physicians, to conduct a rigorous on-site survey of each health plan being considered for accreditation.
NCQA accredited entities
- Humana Insurance Company – Kansas, Missouri, Illinois*, Texas, Utah and Wisconsin* for Commercial PPO
- Humana Insurance Company – Arizona*, Illinois*, Kansas*, Kentucky*, Missouri*, Ohio*, Tennessee*, Texas*, Utah* and Wisconsin* for Medicare PPO
- Humana Medical Plan, Inc. – (Florida), Commercial HMO/POS, Medicare HMO*, Medicaid HMO*
- Humana Health Plan of Texas, Inc. – Commercial HMO/POS
- Humana Health Plan, Inc. –
- Commercial HMO/POS: Arizona, Colorado, Kentucky*, Kansas/Missouri, Illinois, Tennessee*;
- Medicare HMO: Arizona, Colorado, Kansas/Missouri, Texas
- Medicare/Medicaid Dual Demonstration: Illinois
- Medicaid HMO: Kentucky
- Commercial PPO: Kentucky
- Humana Wisconsin Health Organization Insurance Corporation – Commercial HMO/POS* (Wisconsin) and Medicare HMO* (Wisconsin and Ohio)
- Humana Health Plan of Ohio, Inc. – Commercial HMO/POS
- Humana Employers Health Plan of Georgia, Inc. – Commercial HMO/POS, Medicare HMO
- Humana Health Benefit Plan of Louisiana, Inc. – Commercial HMO, Medicare HMO*
- Cariten Health Plan, Inc. – (Tennessee) Medicare HMO*
- Humana Benefit Plan of Illinois, Inc. – Medicare HMO*
- Arcadian Health Plan, Inc (Kentucky) – Medicare HMO
- Go365 – Accredited by NCQA in Wellness and Health Promotion
* Denotes health plans with an accreditation status of Commendable. All other plans have a status of Accredited.