Empowering Intelligent Healthcare Transformation

For over 25 years, Edifecs has led the evolution of the healthcare data interchange process. Customers use our healthcare interoperability platform to unify, normalize and exchange disconnected clinical and financial data, allowing them to uncover the insights and intelligence required to drive an end-to-end alternative payment model ecosystem. This foundation enables us to provide purpose-built AI-powered solutions that accelerate value-based care adoption, optimize risk adjustment and payments, and overcome the complex, labor intensive prior authorization process.

Who We Serve

Health Plans
Collaborate with providers, automate manual processes, lower costs, and drive incremental revenue with our interoperability platform and workflow solutions.
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Healthcare Providers
Embrace alternative payment models and reduce friction while supporting care delivery and patient outcomes with our interoperability platform and workflow solutions.
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Government Agencies
Apply innovative, modern technology to eliminate excessive administrative, maintenance, and compliance challenges while creating a more equitable care framework.
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Integration. Collaboration. Interoperability.

Edifecs is the strategic partner that links payers and providers to empower collaboration and accelerate healthcare evolution.
How will Edifecs’ solutions benefit your organization?
Let’s take a look.

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?

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.

News & Insights


Separating Truth from Hype in Healthcare AI

Over the past year, we’ve seen a rapid expansion of potential use cases for AI, and everyone wants a piece of the action.

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AI in Healthcare: Truth vs. Hype

Artificial intelligence will reshape the healthcare landscape—for better or worse, depending on how the technology is defined and applied

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Risk Adjustment Clinical Suite: The Key to Value-Based Success

By delivering better satisfaction, better clinical outcomes, and better population health, value-based care can transform healthcare.

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AI-Powered Risk Adjustment Coding Suite Explainer Video

To succeed in value-based care, health plans need to take advantage of every opportunity to maximize revenues and ensure complete, accurate payments.

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RISE National 2024: What We Learned

Insights and lessons learned from this year’s RISE National Conference

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Cost Implications of Implementing Cloud Technology in Healthcare

We have talked about implementing cloud technology in healthcare a lot, but there are still a lot of gray areas, such as the cost implications. Will it increase or reduce healthcare costs? More importantly, if we are looking to switch from the traditional on-premises infrastructure, how do the costs compare? Both in where we are today and in the long run?

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