- Operating Rules
- CORE Certification
- Value-Based Payments
- Industry Topics and Comment Letters
- Education and Implementation Resource Center
- Join CORE
- CAQH ProView
- CAQH ProView for Groups
- CAQH ProView - Dental
- Provider Directory - DirectAssure
- Credentialing Solutions Suite
- COB Smart
- CAQH Index
- Provider Data Collaboration
CAQH Committee on Operating Rules for Information Exchange Awards First Certification Seals to The SSI Group, Inc.
IT Company’s ClickON®E-Verify, ClickON®Net Eligibility Products to Follow CORE Phase I Data Rules
WASHINGTON, DC - 12/18/06–
CAQH announced today that The SSI Group, Inc. (SSI) is the first healthcare organization to receive Committee on Operating Rules for Information Exchange (CORE) certification seals, after successfully completing CORE Phase I certification testing – a process ensuring that healthcare organization’s IT systems and products can electronically exchange and verify insurance eligibility and benefits information according to the CORE Phase I rules.
SSI was awarded a CORE Clearinghouse certification seal for its ClickON® E-Verify product and a CORE Vendor certification seal for its ClickON® Net Eligibility product. Edifecs, Inc., a CORE-authorized testing vendor, conducted the certification testing process, which SSI completed in less than half of the 180 days required.
Operating rules build on existing standards, such as HIPAA, to make electronic transactions more efficient, predictable and consistent, regardless of the technology. The CORE rules are modeled on those that make ATM transactions an everyday occurrence in the banking industry and keep electricity flowing in the power industry.
By following the CORE Phase I rules, SSI will help providers quickly and more efficiently verify patient insurance information, including whether a health plan covers the patient, the patient’s benefit coverage and coverage for certain treatments, as well as the patient’s co-pay amount, co-insurance level and base deductible levels (as defined in the member contract). All provider inquiries must be answered within 20 seconds or less, under the rules.
According to the information technology company, SSI also anticipates that its clients will realize efficiencies with workflow, improved data and a greater ability to identify the upfront costs of a patient’s care experience by adopting the CORE rules. In turn, this will improve a provider’s bottom line and provide the patient with a greater understanding of their fiscal responsibilities when receiving medical care.
“Today’s announcement moves U.S. healthcare a large step closer to eliminating the office insurance clipboard,” said Robin J. Thomashauer, CAQH executive director. “The SSI Group is at the vanguard of a revolutionary industry effort to reduce unnecessary healthcare administrative burdens, starting with patient eligibility and benefits verification.”
CAQH launched CORE to promote health plan-provider interoperability and improve provider access to administrative information. To date, the voluntary industry-wide initiative has brought together nearly 100 healthcare industry stakeholders – health plans, providers, vendors, CMS and other government agencies, associations, regional entities, standard-setting organizations and banking industry experts – to develop the operating rules. Those stakeholders cover more than 130 million lives, or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries. Click here for additional information about CORE.
“CORE certification will improve and speed the exchange of eligibility and benefits data for our trading partners and clients, streamlining their business processes and providing them with quality data,” said SSI COO Debbie Short. “By achieving Phase I CORE certification, SSI surpasses the basic regulations set forth by HIPAA for 270/271 eligibility transaction data exchange. The certification process was an efficient process that helped us identify opportunities to improve our applications to take full advantage of the CORE requirements.”
CAQH announced in September that 20 leading healthcare organizations, including Aetna, Inc.; AultCare; Blue Cross Blue Shield of North Carolina; Emdeon; Health Net, Inc.; Health Plan of Michigan; Humana Inc.; Mayo Clinic; McKesson Provider Technologies; Montefiore Medical Center; Siemens; and WellPoint, Inc. and its 14 Blue-licensed subsidiaries, had committed to CORE Phase I rule compliance by March 2007; an additional 20 organizations endorsed the rules. Nearly 70 million Americans are covered by the health plans committed to using the CORE Phase I rules by that date.
The CORE initiative has begun its second phase rules development process, which is scheduled to run through late 2007.
CAQH is a catalyst for healthcare industry collaboration on initiatives that simplify and streamline healthcare administration. CAQH solutions help promote quality interactions between plans, providers and other stakeholders, reduce costs and frustrations associated with healthcare administration, facilitate administrative healthcare information exchange and encourage administrative and clinical data integration. Visit www.caqh.org for more information.
About The SSI Group, Inc.
The SSI Group, Inc. is a national, diversified information technology company established in 1988. It maintains corporate headquarters in Mobile, Ala., and branch facilities in Clearwater, Fla.; Dallas, Texas; Denver, Colo.; and Chesapeake, Va. With approximately 385 employees and 2,200-plus clients nationwide, SSI leads the healthcare field in healthcare claims management technology, EDI platforms and networking. ClickON technology has more than 200,000 built-in edits, delivers HIPAA-certified transactions from Claredi, is EHNAC certified and has 800 payer connections. As a testament to the company’s leadership, the company’s technology processes 250 million transactions annually, totaling in excess of 0 billion. The company offers a wide range of provider/payer/physician services and technologies for managing the revenue cycle - claims processing (ASP/Direct/Clearinghouse), document management and business office outsourcing for paper claims.
# # #