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Operating Rules

How can payers with outdated IT infrastructure, limited time and resources, and high implementation complexity meet and maintain compliance with mandates?

Edifecs Operating Rules is the only comprehensive product-based solution in the market to help health plans achieve and maintain ongoing service levels with CAQH CORE Operating Rules. Edifecs is the first and only CORE authorized certification testing vendor, committed enough to administrative simplification through the use of transactions, that we provide you a free certification testing website available 24/7. The certification platform is supported by an Edifecs team of EDI and Operating Rules subject matter experts. Consulting services are also available to help guide your way from implementation through certification and ongoing service level compliance.
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Capabilities

Edifecs Operating Rules meets stringent response time requirements by deploying out-of-box transaction processing components for eligibility, claim status and EFT/ERA transactions.

Reports compliance

Provides ongoing monitoring and reporting required for compliance attestation.

Connects to trading partners

Connects with trading partners using batch and real-time standardized connectivity methods like HTTP/S, secure certificates, MIME multipart & SOAP/WSDL.

Validates against HIPAA and Service Level Agreements

Validates healthcare transactions against HIPAA standards and Operating Rules.  Queries backend adjudication systems to obtain eligibility and claim status information for transaction enrichment.

Results

Enjoy tangible results of administrative simplification
with Edifecs Operating Rules.

Improves the speed and efficiency of existing trading partner relationships so you can expand your current base of trading partners

Reduces costs, enhances productivity and improves customer satisfaction

Leverages your current investment in Edifecs products by adding new components that help achieve and maintain operating rule compliance

Secures and maintains ongoing compliance to prevent millions of dollars in penalties