Edifecs Core Products are an integrated suite of products that provides comprehensive capabilities for every step in the transaction processing lifecycle.
Edifecs Transaction Management provides a secure end-to-end view of the healthcare transaction lifecycle to internal users and trading partners to enable better business decision-making, monitoring of performance against internal and external SLAs (Service Level Agreements), increasing claims first-pass rates, and improving delivery of customer support.
Edifecs XEngine is a comprehensive message processing system that delivers unparalleled performance and ensures operational integrity of information exchange with trading partners. XEngine provides a rich set of capabilities such as validation, splitting, routing, aggregation, enrichment of transactions and translation between multiple standards.
Edifecs Business Applications are pre-packaged healthcare-specific applications that leverage the power of Edifecs Core Products and provide complete processing capabilities, framework components, visibility and reporting tools for business operations such as enrollment, claim and payment processing.
Edifecs Enrollment Management allows health plans to receive and automatically process enrollment updates in the front-end. Updates can be processed in a variety of formats and submission methods from employers and brokers. This includes comparison of full-files from employers with internal membership systems to determine updates. Enrollment Management streamlines processing of enrollment updates, reduces enrollment-related errors and simplifies enrollment audits.
Edifecs Claim Management provides business rules and processes to improve the processing, routing, tracking and quality of claim submissions from providers. At the front-end, it identifies claim format and business rule errors and initiates corrective action so that providers can correct errors with a self-service portal before claims enter adjudication systems. It manages routing of claims to internal or external systems within the front-end. If also provides a single channel for communicating claim status, errors and requests for additional information with providers.