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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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

Operational Efficiency eBook
In this eBook, we take a look at what’s standing in the way, how to address operational inefficiencies, and how Edifecs’ AI-powered SaaS solutions can help.
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SaaS Solutions in Healthcare
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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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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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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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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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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