Healthcare Solutions | Unified Compliance

Healthcare organizations often use multiple tools to process transactions from partners in different formats (electronic and non-electronic), to ensure they are compliant with industry standards and business rules, and to translate and route data to core systems for processing.

This complexity and use of multiple tools often allows bad data to pass into core processing systems thereby increasing errors and rework, degrading customer satisfaction and impeding achievement of compliance with regulatory mandates. 

The Edifecs Unified Compliance solution provides a channel-agnostic, centralized, single front-end approach to validate, split, route and translate healthcare transactions. It improves transaction workflow and ensures ongoing compliance of production information exchanged with business partners and between business systems. By moving trading partner-specific edits to the front-end, Edifecs Unified Compliance rejects claims with errors before they enter adjudication systems and negatively impact transaction first-pass rates. It includes both design-time and run-time tools to ensure consistency and accuracy through design, testing and production execution.

• Improve transaction quality and achieve compliance by leveraging full support and pre-defined templates for HIPAA and NCPDP standards; validation against ICD-9, ICD-10 and over 60 other code sets; customizing rules to meet company mandates and; by catching errors early using inline validation of inbound and outbound transactions.
• Improve operational efficiencies and generate cost savings by centralizing all message processing that is fragmented across multiple intake mechanisms and channels into a single unified channel with a high-performance, single-pass process to validate, split, acknowledge, route and translate data.
• Reduce support and troubleshooting costs by automatically providing error reports and acknowledgements; using a built-in tracking system to help troubleshoot errors and; by automatically routing bad data to work queues.     
• Improve partner transaction integration by publishing guidelines in multiple formats, de-identifying shared data when necessary, and by testing partner data files against implementation guidelines.

Edifecs Unified Testing solutions are based on the following products and services:

• Edifecs SpecBuilder
• Edifecs XEngine