Edifecs
The Integrated Platform for Payer-Provider Collaboration.
Overview
Edifecs provides a suite of solutions aimed at improving efficiency and collaboration between payers and providers. Their platform handles complex data transactions related to payments, prior authorization, and quality measures. Edifecs has embraced FHIR to modernize these exchanges, offering solutions for CMS interoperability compliance and enabling real-time data flow for value-based care.
✨ Key Features
- Payer-provider data exchange solutions
- Prior authorization automation
- Risk adjustment and quality measurement tools
- FHIR and X12 transaction processing
- Value-based care analytics
🎯 Key Differentiators
- Expertise in streamlining complex data submission and encounter processes.
- Real-time analysis of risk scores.
- Strong focus on ensuring regulatory compliance for payers.
Unique Value: Streamlines the complex data submission and compliance processes for health plans involved in risk adjustment, ensuring accuracy and timeliness.
🎯 Use Cases (4)
✅ Best For
- Helping major health plans comply with CMS interoperability rules
- Streamlining claims and payment processing
- Facilitating data exchange for value-based contracts
💡 Check With Vendor
Verify these considerations match your specific requirements:
- Organizations that only need a clinical FHIR repository
- Small digital health startups not focused on payer/administrative workflows
🏆 Alternatives
Focuses more on the data transaction and compliance layer of risk adjustment, as opposed to the clinical analytics layer of other PHM tools.
💻 Platforms
🔌 Integrations
🛟 Support Options
- ✓ Email Support
- ✓ Phone Support
- ✓ Dedicated Support (Varies by contract tier)
🔒 Compliance & Security
💰 Pricing
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