Health Plans

Connect. Collaborate. Automate.

With Edifecs, health plans can more efficiently partner with providers in real time to create a more connected, efficient, and impactful experience across all markets and lines of business. Our technology makes it easier for payers to exchange and connect data, glean valuable insights that can inform operations, satisfy regulatory and member demands, and scale and grow their value-based care activity. With over a quarter century in healthcare, we understand how health plans work. Our solutions compliantly and efficiently support critical functions and activities, so our clients can focus on leading the way into the next generation of healthcare.


Solving Key Issues Together

Member Enrollment & Experience

Eligibility Claims & Account Management

Digitally Driven Collaboration

Value-Based Care Adoption

Payment Accuracy

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.


Risk Optimization Toolkit
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Enrollment Management for Medicare Advantage
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Fully Automate Prior Authorization at the Point of Care
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