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Disease and Coding Gap Closure
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Insights
Edifecs Tops 2023 Best In KLAS for New CMS Payer Interoperability Category
Edifecs’ flexible, comprehensive platform, Smart Trading, supports all healthcare interoperability standards including FHIR
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Edifecs and VirtualHealth Partner to Automate Prior Authorization for Payers and Providers
Leveraging AI and NLP from recent acquisitions and FHIR® standards, Edifecs and VirtualHealth provide automated prior authorization in real-time
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Prior authorization is one of the last unautomated business processes, yet one of the largest burdens on providers. This has resulted in costly business processes, delayed care, and suboptimal health outcomes. All that is about to change with evolving legislation and technology. By leveraging AI/NLP, X12 278/275, FHIR® standards, and EHR integration, the path to real-time automated prior authorization from the provider’s EHR to the payer’s utilization management is finally within grasp.
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Harness the Power of Your Healthcare Data
Healthcare Data Interoperability
The effective exchange of administrative and clinical data is foundational to core healthcare information processes, compliance, and value-based payment models. Easier said than done, unless you’ve been doing it for more than 25 years.
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Risk Adjustment
Costly. Complex. Manual. These are the descriptors for most risk adjustment solutions in the market today. And these are the problems Edifecs is addressing with a smarter, more comprehensive, and holistic approach.
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Value-Based Payment & Insight
Value-based payment initiatives have moved beyond isolated pilots for micro-segments of members and patients. It’s time for enterprise-wide, standardized and automated programs that unlock the full potential of alternative payment models.
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Enrollment Management
Variable file type ingestion, manual member data validation, and strict intake specifications line up against enrollment programs trying to modernize and centralize onboarding. Enrollment management excellence is achieved with established, proven transaction processing and intelligent enrollment data orchestration by Edifecs.
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