We cannot solve our
problems with the
same thinking we used
to create them
-Albert Einstein

Edifecs is the flexible, reliable, and experienced partner trusted by more than 300 leading healthcare organizations.

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Sally Ride

We all have
natural curiosity
it’s posing questions and
coming up with a method
-Sally Ride

Edifecs reveals insights that help you better understand risk and optimize care quality & health outcomes for individuals and populations.

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Hockey Players

Great moments
are born from
great opportunity
-Herb Brooks

Edifecs creates opportunities for transformation in healthcare by painting a complete and accurate digital portrait of individuals and populations.

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Edifecs launches new
Concurrent Risk Adjustment
solution to elevate
value-based care

Health plans can intervene earlier, close risk gaps, and ensure chronic conditions are fully and accurately captured with Edifecs' Concurrent Risk Adjustment solution.

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FHIR Webinar Graphic

Stoking the FHIR:
Why Strategic Interoperability
is the Key to Prior Authorization
Compliance and Beyond

In this webinar, we take a deep dive into the concept of strategic interoperability, propose a recommended implementation strategy for all CMS-0057-F requirements and deadlines, and share additional use cases beyond 57-F.

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Edifecs

Powering Intelligent Healthcare Transformation

Healthcare is evolving. So are we.

For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on our interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, our solutions have evolved with it. Our cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care.

Explore the Healthcare Cloud

Who We Serve

Health Plans
Collaborate with providers, automate manual processes, lower costs, and drive incremental revenue with our interoperability platform, value-based payments processing, and workflow solutions.
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Healthcare Providers
Thrive in alternative payment model arrangements, reduce administrative burdens, and support care delivery and outcomes with our interoperability platform, risk adjustment, prior authorization, and workflow solutions.
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Government Agencies
Apply innovative, modern technology to eliminate administrative, maintenance, and compliance challenges while creating a more equitable care framework.
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Other Industries
We help government agencies manage costs, improve data quality and access while achieving ongoing compliance and trading partner satisfaction.
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Payers. Providers. Patients. Connected.

Edifecs' interoperability platform and business applications help payers and providers innovate, collaborate, and ultimately deliver better care. It's time to change the game.

Edifecs customers are creating a more connected healthcare industry using our Best in KLAS interoperability platform. We are helping them change the game by providing them the solutions to:

Proven Healthcare Leadership

0+

Leading Health Plans, Providers, and Government Agencies

0+

Years Experience

0M

U.S. Lives Covered by Edifecs Clients

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Best in KLAS: CMS Interoperability - 2024
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Opportunity awaits. Are you ready to join the healthcare transformation?

Learn how Edifecs can help you achieve these outcomes.

News & Insights

Integrating FHIR & EDI: Creating Dual Strategies for Health Plan Success
See how health plans can leverage existing capital investments to develop a comprehensive strategy that integrates FHIR’s flexibility for real-time data access and interoperability with existing EDI infrastructure.
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How the 2024 Election Could Impact Healthcare Data Exchange
How the 2024 Election Could Impact Healthcare Data Exchange
How the 2024 election could influence healthcare data policy.
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Fueling Your FHIR Webinar Q&A
Fueling Your FHIR Webinar Q&A
Questions and answers from our Fueling Your FHIR webinar
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Going Beyond Compliance with Edifecs’ FHIR® Gateway
See how Edifecs’ FHIR Gateway solution helped a health plan not only achieve compliance with CMS-9115-F, but allowed the plan to fully maximize the benefits of implementing FHIR APIs as well.
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Becker's Healthcare 11th Annual CEO + CFO ROUNDTABLE

CEOs, CFOs, and executives from top hospitals and health systems gather at this exclusive, world-class event to address the most pressing issues in healthcare today.

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Adapting to a New Landscape with Edifecs Encounter Submissions
Learn how Edifecs’ Encounter Submissions solution helped a large health plan increase operational efficiency for submitting ACA encounters to CMS, resulting in an acceptance rate of >99% for member and claim submissions.
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