The SSI Group Commits to Adopt CAQH CORE Eligibility and Benefits Rules; Joins 90 Leading Healthcare Organizations in Simplifying Administrative Data Exchange

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The SSI Group, Inc. (SSI) is working to improve the electronic exchange of healthcare eligibility and benefits information through its involvement with The Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE). SSI will work in collaboration with more than 90 other healthcare industry stakeholders, including health plans that cover nearly 125 million commercially insured lives plus Medicare and Medicaid beneficiaries, integrated delivery systems, claims clearinghouses and information technology vendors, to develop the second phase of CORE operating rules.

Ultimately, verifying patients’ eligibility and benefits will be a simple, straightforward and quick process for providers

The SSI Group, Inc. (SSI), a healthcare electronic data interchange (EDI) company, announced today that it has joined 20 leading national healthcare organizations in a first phase project to make it significantly easier for physicians and other health professionals to verify patient insurance information – one of the biggest administrative challenges identified by providers.

In this first phase project, SSI and the other healthcare organizations have committed to electronically exchanging eligibility and benefits information according to operating rules developed through the Council for Affordable Quality Healthcare (CAQH) Committee on Operating Rules for Information Exchange (CORE) by March 31, 2007.

Operating rules build on existing standards to make electronic transactions more efficient, predictable and consistent, regardless of the technology. The CORE Phase I rules build upon the HIPAA Transaction Code Sets for eligibility inquiry and response (270/271). CORE’s goal is to allow providers to submit a benefits/eligibility verification request using the electronic system of their choice, answer those requests within 20 seconds and obtain the corresponding benefit/eligibility data for any patient and from any participating health plan.

“CORE brings together key members of the healthcare industry to address this important component of a provider’s business process,” said Debbie Short, SSI’s Chief Operations Officer. “The unique blending of expertise provided by the providers, payers, clearinghouses and IT vendors involved in this effort will facilitate improved submission of eligibility and benefits inquiries and receipt of a real-time response.”

SSI also announced today that it has joined the CORE initiative as a participating organization. SSI will work in collaboration with more than 90 other healthcare industry stakeholders, including health plans that cover nearly 125 million commercially insured lives plus Medicare and Medicaid beneficiaries, integrated delivery systems, claims clearinghouses and information technology vendors, to develop the second phase of CORE operating rules.

“Ultimately, verifying patients’ eligibility and benefits will be a simple, straightforward and quick process for providers,” Short added. “Providers will receive more reliable data from payers, helping them counsel their patients on their fiscal responsibilities with a firm understanding of co-pays, deductibles and other coverage information.”

As one of its products, SSI has offered eligibility verification technology for 10 years. SSI’s ClickON Technology facilitates HIPAA transactions for claims (837I&P) as well as eligibility requests/inquiries (270/271), claims status request/inquiry (276/277), remittance advice (835) and precertification/authorization (278). SSI also offers an extensive payer offering with more than 800 available payers, representing thousands of health plans. Payer connectivity includes a wide variety of commercial and government healthcare payers, including Medicare, through an EHNAC-certified clearinghouse/Data Center and the industry’s first direct-to-payer claims submission solution.

About CAQH

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 http://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 $300 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. http://www.thessigroup.com

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