Health Plans

Connect. Collaborate. Automate.

The healthcare landscape is becoming more and more complex. To effectively manage that complexity, health plans need a robust and flexible tech infrastructure that can support their business operations. That’s what we deliver.

Edifecs’ SaaS-based modular solutions make it easier for payers to efficiently exchange and connect data to satisfy regulatory requirements and deliver a better member experience. By incorporating AI technology into our solutions, we help health plans glean valuable insights to inform operations and support growth in value-based care.

Backed by over a quarter century of healthcare experience and expertise, our solutions are the difference-maker health plans can rely on as they lead the way into the future of healthcare.

Solving Key Issues Together

Accelerate VBC Adoption

Be a Transformative Partner

Enhance Operational Efficiency

Improve Financial Performance


Proven Health Plan Experience

27 of 36 Blue Plans

Blues Plans

10 of 10 National Health Plans

National Health Plans

35 of 52 State Medicaid Programs

State Medicaid Programs

Solutions for Health Plans

Risk Adjustment
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Value-Based Payment & Insight
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Enrollment Management
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Healthcare Data Unification
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Prior Authorization
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Find out how we can support your health plan’s performance.

Resources

AI in Healthcare: Truth vs Hype
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Flexibility and Control: Growing with Edifecs Enrollment Management
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Meaningful Applications for Healthcare AI Webinar
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