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Text Content

 * What We Solve
   
   Healthcare Transformation
   Starts Here
   
   The Edifecs Healthcare Cloud and Smart Platform combination enables business
   and technology users to innovate and scale faster, collaborate with
   stakeholders, comply with evolving mandates, and manage performance.
   
   Learn More
    * Healthcare Interoperability Cloud
      
      Unified solutions to connect, orchestrate, enhance, and exchange clinical
      data
      
      >
      * EDI Gateway
      * FHIR Gateway>
        * Cloud Member App
        * CMS-0057-F
        * Payer to Payer Data Exchange
      * Smart Trading Platform>
        * Bi-Directional Data Exchange
        * Electronic Transactions
        * Integration Engine
        * Transaction Specifications
    * Healthcare Operations Cloud
      
      Comprehensive solutions to transform value-based care contracting,
      administration, and delivery
      
      >
      * Encounter Submissions
      * Enrollment Management>
        * ACA Marketplace
        * Group Enrollment
        * Managed Medicaid
        * Medicare Advantage
      * Prior Authorization
      * Risk Adjustment>
        * Clinical Suite
          * Pre-Visit Prep
          * Point of Care Advisor
          * Post-Visit Review
          * Retrospective Review
        * Coding Suite
          * Concurrent Risk Adjustment
          * Retrospective Review
      * Value-Based Payment & Insight>
        * Population Payment Management

 * Who We Serve
    * Health Plans
      >
      * EDI Gateway
      * Encounter Submissions
      * Enrollment Management
      * FHIR Gateway
      * Prior Authorization
      * Risk Adjustment Coding Suite
      * Smart Trading Platform
      * Value-Based Payment & Insight
    * Healthcare Providers
      >
      * Population Payment Management
      * Prior Authorization
      * Risk Adjustment Clinical Suite
    * Government Agencies
      >
      * EDI Gateway
      * FHIR Gateway
      * Smart Trading Platform
      * Value-Based Exchange
    * Other Industries
      >
      * Smart Trading Platform

 * Healthcare Technology
    * Edifecs Healthcare Cloud
    * Edifecs SaaS
    * AI Solutions
    * Security

 * News & Insights
   
   Integrating FHIR & EDI: Creating Dual Strategies for Health
   Plan Success
   
   Our experts explore how health plans can leverage existing capital
   investments to develop a comprehensive strategy that integrates FHIR's
   flexibility for real-time data access and interoperability.
   
   Watch Now
    * Blog
    * Events
    * Newsroom
    * Knowledge Center
    * Resource Library
    * Edifecs University

 * About Edifecs
    * Who We Are
    * Awards
    * Careers
    * Contact Us
    * India
    * Leadership
    * Sustainability

 * Contact Us

info@edifecs.com(425) 435-2000

We cannot solve our
problems with the
same thinking we used
to create them
-Albert Einstein

Edifecs is the flexible, reliable, and experienced partner trusted by more than
300 leading healthcare organizations.

Learn More  ❯

We all have
natural curiosity
it’s posing questions and
coming up with a method
-Sally Ride

Edifecs reveals insights that help you better understand risk and optimize care
quality & health outcomes for individuals and populations.

Learn More  ❯

Great moments
are born from
great opportunity
-Herb Brooks

Edifecs creates opportunities for transformation in healthcare by painting a
complete and accurate digital portrait of individuals and populations.

Learn More  ❯

Edifecs launches new
Concurrent Risk Adjustment
solution to elevate
value-based-care

Health plans can intervene earlier, close risk gaps, and ensure chronic
conditions are fully and accurately captured with Edifecs' Concurrent Risk
Adjustment solution.

Learn More  ❯
PreviousNext


EDIFECS

--------------------------------------------------------------------------------


POWERING INTELLIGENT HEALTHCARE TRANSFORMATION

Healthcare is evolving. So are we.

For over 25 years, Edifecs has been a market leader in healthcare data
interchange. Hundreds of health plans, providers, and government agencies rely
on our interoperability solutions to unify, normalize, and exchange clinical and
financial data. As the healthcare industry has evolved, our solutions have
evolved with it. Our cloud-native, AI-powered solutions are designed to help
healthcare organizations thrive in value-based care.


Explore the Healthcare Cloud


WHO WE SERVE

Health Plans
Collaborate with providers, automate manual processes, lower costs, and drive
incremental revenue with our interoperability platform, value-based payments
processing, and workflow solutions.
Learn More  ❯
Healthcare Providers
Thrive in alternative payment model arrangements, reduce administrative burdens,
and support care delivery and outcomes with our interoperability platform, risk
adjustment, prior authorization, and workflow solutions.
Learn More  ❯
Government Agencies
Apply innovative, modern technology to eliminate administrative, maintenance,
and compliance challenges while creating a more equitable care framework.
Learn More  ❯
Other Industries
We help government agencies manage costs, improve data quality and access while
achieving ongoing compliance and trading partner satisfaction.
Learn More  ❯


PAYERS. PROVIDERS. PATIENTS. CONNECTED.



Edifecs' interoperability platform and business applications help payers and
providers innovate, collaborate, and ultimately deliver better care. It's time
to change the game.

Edifecs customers are creating a more connected healthcare industry using our
Best in KLAS interoperability platform. We are helping them change the game by
providing them the solutions to:

--------------------------------------------------------------------------------


PROVEN HEALTHCARE LEADERSHIP

300+

Leading Health Plans, Providers, and Government Agencies

26+

Years Experience

292M

U.S. Lives Covered by Edifecs Clients

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OPPORTUNITY AWAITS. ARE YOU READY TO JOIN THE HEALTHCARE TRANSFORMATION?

Learn how Edifecs can help you achieve these outcomes.

Connect With Us


NEWS & INSIGHTS

Operational Efficiency eBook
In this eBook, we take a look at what’s standing in the way, how to address
operational inefficiencies, and how Edifecs’ AI-powered SaaS solutions can help.
Learn More  ❯
Embracing SaaS: Why Healthcare Organizations Should Transition from On-Premise
Solutions
Explore how SaaS solutions in healthcare offer quick updates, enhanced security
and compliance, and reduced internal resource burdens.
Learn More  ❯
Integrating FHIR & EDI: Creating Dual Strategies for Health Plan Success
See how health plans can leverage existing capital investments to develop a
comprehensive strategy that integrates FHIR’s flexibility for real-time data
access and interoperability with existing EDI infrastructure.
Learn More  ❯
Going Beyond Compliance with Edifecs’ FHIR® Gateway
See how Edifecs’ FHIR Gateway solution helped a health plan not only achieve
compliance with CMS-9115-F, but allowed the plan to fully maximize the benefits
of implementing FHIR APIs as well.
Learn More  ❯
HEDIS® & Quality Improvement Summit

The HEDIS® & Quality Improvement Summit is the only conference dedicated to
quality improvement and driving HEDIS® efforts.

Learn More  ❯
A Working Approach to the Payer-to-Payer Provision in CMS-0057-F
In this WEDI presentation, Edifecs Product Manager Artem Sopin details a
solution to support the Payer-to-Payer FHIR API provision of CMS-0057-F and
support a more streamlined exchange of patient data between payers.
Learn More  ❯

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First Name
required
Last Name
required
Email Address
required
Phone Number
required
Company
required
Job Title
Please choose your market type
required
- Select -Health Plan or MCOState or Government AgencyHospital SystemPhysician
Group or ClinicAccount Care Organization (ACO)Other Healthcare
OrganizationHealthcare Vendor/ServicesOther Industry
Comments
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