Prime Health Services developed a SaaS solution called CORE that automates PPO reductions to electronic medical bills. Clients that use CORE have real-time access to our current PPO network, allowing almost instantaneous repricing results. Prime Health has pioneered the way for real-time repricing, which was traditionally a timely process using batch methods.
To accommodate clients, Prime Health offers both batch and real-time solutions. While the real-time connection is our ‘plug-and-play’ solution, we are able to accept industry standard electronic formats designated for use by HIPAA (837 X223, X222), as well as custom proprietary formats from several bill review vendors. The batch solution incorporates secure FTP technology, a custom translation engine, and the CORE real-time pricing service. When files are received over a secure channel, our translation engine interprets each data element and passes that information off to CORE. Bills are priced in real time, which then is translated into a new batch file, if that is the desired route a client needs. Since this approach incorporates real-time technology, turnaround time is measured in minutes instead of days.
Prime Health has offered PPO repricing services through via CORE since 2006; and in January 2012 launched a new version of CORE based on cloud technologies. With scalability and redundancy in mind, CORE was built on top of the Windows Azure platform, Microsoft's cloud solution. This technology allows CORE to have a 99.9% uptime, and also allows unlimited scalability as our network of medical providers and client base grows. Prime Health's aim is to deliver an always-available repricing service capable of sub-second bill repricing.
Not only is CORE extremely fast, it was architected to handle healthcare data securely. CORE is designed to meet clients’ security, privacy, and compliance requirements and is hosted in a data center that meets CMS standards for processing healthcare claims in a cloud environment. Prime Health’s cloud service provider is compliant with Service Organization Control (SOC) 2–Type 2 security commitments and achieved FedRAMP compliance at the ‘Moderate Impact’ level. CORE exposes a secure interface, utilizing SOAP and XML communication technologies. Transmissions to CORE are encrypted with a 256 bit AES cypher, and uses the latest TLS 1.2 protocol. CORE was designed to be stateless and does not retain any record of past bills.
In addition, Prime Health Services itself received its Service Organization Control (SOC) 2–Type 1 attestation engagement report in October 2016, affirming that Prime Health’s information security practices, policies, procedures, and operations meet the SOC 2® standards for security, availability, and confidentiality.
For clients, this key technological service monitors and manages the regular flow of medical bills, ensuring timely processing, and also ensures proper data synchronization between the live site and internal systems. Clients who choose to utilize Prime Health have the benefit of receiving their response in real-time thanks to the development and ongoing maintenance of CORE.
Service Built with Uptime and Scalability in Mind
CORE is Prime Health's repricing engine that was developed using the latest in cloud technology. With scalability and redundancy in mind, CORE was built on top of the Windows Azure platform, Microsoft's cloud solution.
This technology allows CORE to have a 99.9% uptime, and also allows unlimited scalability as our network and client base grows. Prime Health's aim is to deliver an always available repricing service capable of sub-second bill repricing and PPO discount application.
>>When an F-1 tornado damaged our office building, CORE was unphased.
>>When the 100-year flood hit Nashville, CORE kept processing medical bills for clients.
>>When we implemented our business continuity plan due to the COVID-19 pandemic, CORE continued to run smoothly for clients and providers alike.