In healthcare, Standard Development Organizations (SDOs) play a crucial role in creating and maintaining standards that ensure the interoperability, safety, and quality of healthcare systems and services. These organizations work collaboratively with healthcare providers, insurers, software developers, and other stakeholders to develop standards that enhance the efficiency and effectiveness of healthcare delivery.
ASC X12
The ANSI Accredited ASC X12 is responsible for developing and maintaining the X12 EDI Standard and Implementation Guides across the transportation, supply chain, and insurance industries.
X12N Insurance
X12N is responsible for developing and maintaining the X12 EDI Standards and Implementation Guides related to the insurance industry, including property and casualty insurance, health care insurance, life insurance, annuity insurance, reinsurance, and pensions. Health insurance activities include those undertaken by commercial and government health care organizations.
Visit X12.org for more information.
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CAQH CORE is a non-profit organization that creates and maintains national operating rules for electronic healthcare administrative transactions. The CAQH CORE Operating Rules streamlines automation and business processes that supports better outcomes for patients, providers, and health plans.
For more information, visit CAQH CORE
October 10, 2024: CAQH CORE recommends updated and new Operating Rules to NCVHS. For more information, visit CAQH CORE 102024 Recommendations. Recommendations include:
July 2025: CAQH CORE Eligibility & Benefits (270/271) Data Content Rule vEB.2.1 (published June 2025) was reviewed on a LIVE webinar:
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Health Level Seven (HL7) is a set of standards that govern the exchange, integration, sharing, and retrieval of electronic health data primarily in the clinical space. You can get more information about HL7 by visiting https://www.hl7.org/index.cfm
NCPDP is an ANSI-accredited Standards Development Organization (SDO), incorporated in 1977, developed to serve the needs of pharmacy as well as the greater healthcare industry. They pioneered the creation of the Universal Claim Form to expedite the reimbursement of pharmacy claims. Two of their most notable standards are the Telecommunications Standard, which allows for real-time prescription claim processing, and the SCRIPT Standard, which enables ePrescribing.
Interoperability of healthcare data is incomplete without pharmacy. This is showcased in the HITAC Pharmacy Interoperability and Emerging Therapeutics Task Force 2023 Recommendations Transmittal Letter November 9, 2023.
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