Edifecs


Cotiviti + Edifecs

By bringing together Edifecs' industry-leading health data management platform with Cotiviti's advanced technology, data analytics, and specialized expertise, our unified organization will deliver exceptional value to healthcare organizations as they seek to provide better care at lower cost.

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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

300+

Leading Health Plans, Providers, and Government Agencies

26+

Years Experience

292M

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

WEDI Summer Forum

Edifecs will be joining WEDI’s Summer forum, where the brightest minds in our industry converge to discuss and shape the future of healthcare.

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The Evolution of AI in Healthcare Operations
The Evolution of AI in Healthcare Operations
How AI has evolved to meet the changing needs of healthcare organizations.
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Encounter Management Solution Explainer Video
Managed Care Organizations (MCOs) are looking to maximize encounter submission accuracy, compliance, and first-pass rates. Yet fragmented encounter data, disparate systems, and manual, inefficient workflows are barriers that can lead to revenue leakage. Plus, as plans expand into new markets and have more members, claims data, and complex rules, outdated systems aren’t enough.
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Third-Party Health Technologies and Data Privacy in Medicare Edifecs
Third-Party Health Technologies and Data Privacy in Medicare
How CMS’ new RFI for digital health tech could impact data privacy.
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MESC

MESC is a national conference and community for state, federal, and private sector individuals to exchange ideas related to Medicaid systems and health policy affected by those systems.

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State of Affairs of the Medicare Advantage Risk Adjustment Model
State of Affairs of the Medicare Advantage Risk Adjustment Model
A closer look at the risk adjustment model for Medicare Advantage (Part C).
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