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The SSI Group Achieves Phase IV CAQH CORE Certification for Seamless, Secure Healthcare Administrative Data Exchange

05.22.20 • Press Release

The SSI Group announced today that it achieved the Phase IV CAQH® Committee on Operating Rules for Information Exchange (CORE®) Phase IV Certification Seal.

Operating rules and underlying standards enable health plans, healthcare providers, and vendors to electronically share large quantities of administrative data quickly, cost-effectively, and accurately. By specifying the business actions each party must follow in these transactions, the rules reduce costs and improve the efficiency of the nation’s healthcare system.

The CORE Certification Seal was awarded after The SSI Group successfully completed a thorough and independent testing process and a subsequent application review. This ensures that providers can gain access to a richer set of consistent and accurate electronic administrative data, such as claims acknowledgments and prior authorization from health plans following a common set of national operating rules.

The Phase IV CAQH CORE Operating Rules build upon the first three phases to develop a national set of infrastructure expectations across all HIPAA claims-related transactions. Transactions covered under Phase IV include acknowledgment of claims and prior authorization and offer significant savings potential. For example, increased adoption of electronic prior authorization transactions has the potential to save the health plans and providers $9.25 per transaction or more than $400 million annually.

Phase IV also contains the first operating rules for transactions between employers and health plans. The acknowledgment requirement for employee premium payments and enrollment and dis-enrollment in a health plan will reduce processing delays and avoidable errors by communicating in real-time the receipt and status of information.

“By adopting operating rules, demonstrating compliance and urging its business partners to do so as well, The SSI Group is showing leadership in the industry,” said Robin J. Thomashauer, CAQH Executive Director. “Operating rules are most effective when everyone follows them, and today, thanks to The SSI Group, our nation’s healthcare system has taken another important step forward.”

The U.S. Department of Health and Human Services selected CAQH CORE to develop national operating rules for HIPAA transactions to ensure that large amounts of data can be shared electronically in a fast and efficient way. Widely viewed as the industry “gold standard,” the CORE Certification Program enables organizations to demonstrate that they and their business partners have adopted and are adhering to the operating rules and their underlying standards, plus going above and beyond what is required.

CAQH CORE is a multi-stakeholder collaboration of nearly 130 organizations that work together to develop operating rules. Participants represent healthcare providers, health plans, vendors, associations, government entities and the organizations that set standards for healthcare and data exchange. Four phases of CAQH CORE Operating Rules have been issued to date, and CORE Certification is currently available for all phases of the rules.

To learn more about CAQH CORE, visit www.caqhcore.org.