Integration and Interoperability.
Essential. Smart Trading

A one-stop solution for digital health information interoperability underpinning healthcare partnerships.

Smart Trading

Smart Trading enables partners to collaborate with confidence to streamline administrative functions and power value-based care programs with clinical and pharmacy data. By consolidating administrative and clinical data exchange into one platform, Edifecs Smart Trading dramatically reduces IT infrastructure and administrative costs.

Digital Health Information Interoperability

At the intersection of consumerism in healthcare, value-based reimbursement and population health management is the need to exchange administrative documents, clinical data and patient adherence to care programs. Digital interoperability requires more than syntax and semantic validation. Digital interoperability incorporates mobile health and precision medicine data to improve outcomes. Edifecs delivers digital health interoperability through Smart Trading.

Consolidate information exchange for all your partners in our proven integration engine. Use Smart Trading to deliver the digitized data necessary for value-based reimbursement, population health management, consumer programs and administrative simplification.

Value Proposition

$0.60 - $0.75 PMPY

Reduce Administrative Costs

Reduce claim pre-processing costs

Reduce manual adjudication

Reduce partner onboarding costs

Reduce EDI and clinical transaction costs

$0.75 - $1.25 PMPY

Reduce IT TCO

Consolidate administrative and clinical trading infrastructure

Reduce the costs of change through configuration

Reduce the costs of change through configuration

These values are based on industry benchmarks for a regional health plan with 1.5 to 2 million members.
Actual numbers will vary based on the need to onboard/manage trading partners, claim volume and EDI infrastructure in use.

 
  • CS

    Case Study

    Voice of Customer

    "Engaging an experienced partner such as Edifecs, enabled us to gain insights and define action items to address concerns with claims and enrollment intake processes. We received a detailed guide to improve quality, service and costs that fit the parameters of our current IT landscape and business goals."

    - Senior Claims Processing Leader, Regional Health Plan

  • DS

    Data Sheet

    Voice of Customer

    "The Edifecs platform provides BCBSVT trading partners and groups with a 'self-service' website to validate their EDI files against HIPAA standards as well as BCBSVT business rules. The platform also provides trading partners and groups with real time reporting as BCBSVT processes their EDI files and HIPAA level validation and error reporting that was not available with the current EDI platform."

    - Bob West, Director of Core Applications

Overview

Edifecs Smart Trading delivers interoperability in an integrated healthcare information pipe. Connect and control partner interactions with Edifecs SpecBuilder and XEngine Server. Use standardized and proprietary formats from our extensive library. Control interactions to increase data quality and compliance. Access information about current and archived partner interactions. Serve partners and patients more efficiently using Edifecs Transaction Management. Connect information to context for members, trading partners and providers to increase customer service responsiveness and resolve issues quickly. Accelerate your programs by using an industry leading interoperability solution to power mission critical information flow.
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Integration

With all trading partners through a single gateway–enabling interoperability with the trading partners

Connectivity

As the number of connections increase, so will the languages and dialects that different organizations use to communicate the data

Processing

Must ensure compliance and intelligent processing. Data quality and intelligent processing of the data will be key to success

Optimization

Tracking, visibility, exception management and trend analysis are must-haves for continuous optimization and improvement

Product Spotlight

  • XEngine Server

    Gain unmatched performance and throughput for transaction processing with industry leading run-time interoperability solution. XEngine Server minimizes processing delays, reduces integration challenges and increases first-pass rates. And, in-stream processing allows transactions to be validated against standards (HIPAA/EDI, HL7, NCPDP, etc.), and enriched through data lookups, code set verification (ICD-10), and business rules—increasing the integrity of partner exchange.

  • Transaction Management

    Use industry’s leading visibility solution to gain new insight into encounters, episodes of care and claims in one integrated, time-sequenced view. Understand the context of the event and message to make an informed decision. Manage partners more effectively. Partner interactions are correlated to organize related messages, deliver trend reports and rich search functions – including keyword searches. Reduce hours of research to minutes with Transaction Management.

  • SpecBuilder

    Use the gold standard in design-time environments. Edifecs SpecBuilder is simple and easy to use with a library of over 30,000 specifications (HIPAA 5010, EDIFACT, HL7, CCD). Author, validate and publish specifications including out of the box support for WEDI SNIP levels 1-7. Relax or tighten business rules using the integrated environment to test specifications and publish automatically. Build a foundation for data liquidity for all lines of business and multiple downstream applications. Reduce the time, cost and complexity of connecting and exchanging data.

Capabilities

Smart Trading is an industry-leading healthcare integration engine. Connect efficiently and govern data exchange to create interoperability with all your partners. Then, correlate clinical and administrative data to access real-time visibility of member interactions. Use Smart Trading to create the data and process foundation to consume the exponentially growing digital healthcare data that is essential to shifting to value-based care programs.

Learn how Smart Trading can be used in your business.


 

Approach

Smart Trading is uniquely positioned at the front end of the information pipe between healthcare entities to scale their partnerships. Harness our industry-leading integration solution to power agile applications and collaboration tools to automate the new business models driving your partnerships.

Edge-based innovation best supports industry initiatives. Its natural advantage is the ability to quickly connect and integrate, validate transactions to reduce downstream costs and provide actionable data to improve service.


 

Industry Initiatives Enabled

RETAIL ORIENTATION & CONSUMERISM

Payers need to connect to new partners such as public and private exchanges. These partners exchange enrollment and payment data that consists of multiple transaction types such as additions, changes and full-file audit

POPULATION HEALTH MANAGEMENT

Interoperability is fundamental for scaling population health initiatives. This creates requirements to integrate clinical data from multiple sources into a single comprehensive view of the patient

ADMINISTRATIVE 
SIMPLIFICATION

Measuring value requires exchanging clinical outcomes for comparison to previous year and industry norms. Value Based Reimbursement also requires the exchange of budget, member attribution data, etc., for successful administration

SHIFT FROM 
VOLUME TO VALUE

Reducing administrative costs requires automation and use of standards prescribed by HIPAA, CAQH CORE, etc.   Administrative simplification streamlines payer / provider processes by increasing automation rates

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