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.


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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Payers. Providers. Patients. Connected.

Edifecs’ AI-infused 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:

  • Accelerate Value-based Payments
  • Attain Complete, Accurate Care Funding
  • Automate Prior Authorization
  • Enable Interoperability and Collaboration

Learn how we can help you change the game.

Integration. Collaboration. Interoperability.

Edifecs is the strategic partner that links payer and providers to improve collaboration and accelerate healthcare evolution
How will Edifecs’ solutions benefit you?

Let’s take a look.

Friction
Connectivity
Efficiency
Costs
Collaboration
Revenue
Explore Our Platform

Proven Healthcare Leadership

26+ Years Experience

Years Experience

Trusted By 300 Healthcare Companies

Leading Health Plans, Providers, and Government Agencies

292M Lives Covered

U.S. Lives Covered by Edifecs Clients


Opportunity awaits. Are you ready to join the healthcare transformation?

News & Insights

Edifecs_Interoperability_eBook

A Guide to Unlocking Operational Efficiency

Value-based payment models are growing in scope and complexity, demanding a greater investment of time and resources to manage processes like claims processing, performance measures, and plan configurations.

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Edifecs_Healthcare_Interoperability_Blog

Embracing SaaS: Why Healthcare Organizations Should Transition from On-Premise Solutions

Explore how SaaS solutions in healthcare offer quick updates, enhanced security and compliance, and reduced internal resource burdens.

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Alternative_Payement_Models_Edifecs_Video

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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Edifecs_Healthcare_AI_Case_Study

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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Las Vegas, NV

HEDIS® & Quality Improvement Summit

The HEDIS® & Quality Improvement Summit is the only conference dedicated to quality improvement and driving HEDIS® efforts.

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Risk_Adjustment_In_Healthcare_Edifecs_Webinar

A Working Approach to the Payer-to-Payer Provision in CMS-0057-F

In this WEDI presentation, Edifecs Product Manager Artem Sopin details a solution to support the Payer-to-Payer FHIR API provision of CMS-0057-F and support a more streamlined exchange of patient data between payers.

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