The SSI Group Becomes First Vendor to Achieve CORE Phase I Rules Certification Seals

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CAQH Committee on Operating rules for Information Exchange Awards first certification seals to The SSI Group, Inc.

There were 56 tests required that certified our ability to act as both an information source and information requestor in accordance with CORE requirements. Edifecs test suites were integrated with our Eligibility Clearinghouse to test its conformance in both batch and real-time modes.

The SSI Group, Inc. (SSI), a healthcare electronic data interchange (EDI) company, is the industry's first organization to achieve CAQH Committee on Operating Rules for Information Exchange (CORE) Phase I rules certification seals, accomplishing the feat as both a clearinghouse and software vendor.

"We are proud to be the first vendor to meet CORE's Phase I rules certification requirements after aggressively focusing our efforts to meet these requirements as soon as possible," said SSI COO Debbie Short. "Our clients will benefit from data simplification and a reduced time frame for eligibility and benefit data exchange."

In October, SSI committed to adopt CAQH CORE eligibility benefit rules. By committing to CORE's Phase I rules, SSI pledged to electronically exchange patient eligibility and benefit information according to the CORE operating rules by March 31, 2007. These operating rules simplify the eligibility verification process, enabling healthcare providers to submit a benefit/eligibility verification request and receive a response within 20 seconds from CORE-certified healthcare organizations.

SSI's ClickON® E-Verify and ClickON® Net Eligibility software are the company's applications that were tested, along with the company's Eligibility Clearinghouse. These applications transmit the request for eligibility and benefit information and receive the response from the insurance payer. Requests can be made either in a real-time environment or via a batch where many requests are made at one time. Responses are displayed in a standardized format or in a batch file.

"By achieving CORE certification, The SSI Group has demonstrated commitment to improving electronic data exchange between health plans and providers," said Robin J. Thomashauer, CAQH executive director. "CAQH encourages all of SSI's clients using the ClickON E-Verify and Net Eligibility products to become CORE-certified, and join the revolution to improve patient eligibility and benefit verification."

The CORE certification testing process was extensive and involved a collaborative effort between SSI, CAQH staff and Edifecs, which provides B2B interoperability testing and the CORE testing platform. The testing process was also unique for SSI because the company tested as both an eligibility source and requestor. As a source, SSI houses eligibility data and also provides a clearinghouse to interface with insurance payers to transmit healthcare insurance eligibility and benefit data to providers.

"To reach certification, our research and development team worked closely with CAQH and Edifecs," Short said. "There were 56 tests required that certified our ability to act as both an information source and information requestor in accordance with CORE requirements. Edifecs test suites were integrated with our Eligibility Clearinghouse to test its conformance in both batch and real-time modes."

SSI's ClickON Technology facilitates HIPAA transactions for claims (837I&P), eligibility request/response (270/271), claims status request/inquiry (276/277), remittance advice (835) and precertification/authorization (278). ClickON's workflow capabilities automate the healthcare revenue cycle, enabling processing tasks to be accomplished in less time by fewer people.

Benefits derived from this seamless integration of technology and workflow include eliminating the reformatting of electronic data, reducing redundant data entry and increasing data validation and reporting. SSI also offers an extensive payer offering with more than 800 available payers, representing thousands of health plans.

About CORE and 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.

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 industry stakeholders (, including health plans, providers, vendors, the Centers for Medicare and Medicaid Services and other government agencies, associations, regional entities, standard-setting organizations and others, that cover more than 130 million lives, or more than 75 percent of the commercially insured plus Medicare and state-based Medicaid beneficiaries. In collaboration, they have built consensus on a set of operating rules to:

· Enhance interoperability between providers and payers

· Streamline eligibility and benefits data transactions

· Reduce the amount of time and resources providers spend on administrative functions - time better spent with patients

CORE Operating rules build on existing standards, such as HIPAA, to make electronic transactions more predictable and consistent, regardless of the technology.

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About Edifecs

Edifecs helps organizations achieve interoperability and return on investment by simplifying the adoption of standard electronic transactions and deriving business value from trading partner communities. The Edifecs Healthcare SuiteTM includes business performance management applications that automate and manage the full lifecycle of transactions; defining requirements, community enablement, testing and data validation, real-time transaction monitoring, repair and reconciliation, and providing transaction analytics.

2006 marks 10 years of Edifecs' expertise in providing innovative technology solutions to over 1600 customers worldwide. Edifecs has over 300 customers and partners in healthcare that include 16 Blue Plans, 35 Medicaid, State and Federal Agencies, along with partnership arrangements with most leading middleware stack vendors. Edifecs is the sponsor of CollabrusTM, one of healthcare's largest third party testing and certification services with over 10,000 members. Founded in 1996, Edifecs is headquartered in Bellevue, WA. Company website: Contact: Kevin Pierce 425-452-0622.

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.


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Thomas Mitchell
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