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Comply with mandates. Simplify and save.

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How can payers with outdated IT infrastructure, limited time and resources, and high implementation complexity meet and maintain compliance with mandates?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


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