Harness your healthcare data

Enable interoperability, assure compliance, correlate clinical and administrative data and deliver real-time visibility of each partner data exchange.

Administrative Simplification

There is significant pressure on healthcare organizations to automate business processes and scale infrastructure, meet industry-wide and legislative requirements, and lower overall costs. All while adhering with healthcare regulations and processes (e.g. HIPAA, HITECH, ICD-10, CAQH CORE, state initiatives and clinical/administrative data integration).

Our Solutions

All post-reform healthcare initiatives require compliant data exchange. Edifecs Smart Trading dramatically reduces infrastructure and administrative costs. The solution supports any-to-any interoperability and delivers industry leading visibility into transactions and member activity.

The compliance suite governs partner exchange to reduce costs and risk at every stage - planning, cross-walking code sets, testing and monitoring.

Smart Trading

  • Award winning design-time toolset for spec building and QA testing.
  • Unmatched performance to validate, transform and process healthcare transactions.
  • Deep insights into healthcare transaction lifecycle for proactive interventions.
  • Automation of cross-enterprise workflow into existing claims and clinical systems.
  • Simplified clinical data integration, comprehensive support for interoperability standards.

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  • Manage the compliance lifecycle of rules and mandates that govern healthcare.
  • Maintain ongoing service levels with CAQH CORE Operating Rules.
  • Identify financial variances of code changes (ICD, CPCs, and DRGs) and transitions.
  • Collaborative end-to-end testing between payers/providers (3,000 proven test scenarios).
  • Reduce the risk and costs of mandates from HHS, CMS or State Agencies.

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Who We Help

Health Plans

Edifecs simplifies data ingestion and consolidates any data source including complex clinical systems to reduce administrative costs, automate processes, and ensure compliance.

Healthcare Providers

Edifecs has solutions to bridge the payer/provider collaboration gap reducing costs associate with claims (attachments) to ensure quicker and accurate reimbursements.


Edifecs is well positioned as a single data broker for both claims and clinical data that reduces an ACO’s total cost of investment in technology, while still providing visibility into the entire patient/member data history.

Government Agencies

We provide CMS and state Medicaid agencies the ability to consume data in any format on any system removing the IT challenges of data exchange.