Comply with HIPAA, CAQH and ICD‑10

Automate compliance management reducing costs and risks for the business.

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Compliance Solutions

Mandates like HIPAA/HITECH, CAQH CORE Operating Rules, ICD-10, and others, lay important groundwork that standardizes trading of administrative and clinical data. Maintaining ongoing compliance of these mandates, eliminating trading partner complaints, and avoiding adverse findings during HHS/CMS audits still can be an operational challenge. With penalties surpassing 1.5mil per incident, organization must be vigilant on every phase of the compliance process from assessment/planning and collaborative testing to implementation and ongoing monitoring.

Our Approach

As the recognized leader in compliance, electronic data interchange (EDI) and administrative simplification, Edifecs has a comprehensive compliance suite. No matter where you are on your journey to compliance, our award-winning products and the experts on our services teams can help to accelerate compliance and set up ongoing monitoring to ensure you maintain it.

Start with our free CORE Certification Testing Platform where 150 organizations have achieve their CORE certifications.

Our Products

Address ICD-10 transition risks

Are you one of the 72% of organizations that hasn’t performed any revenue impact testing? Get started with comprehensive testing and analytics to quantify risk and impact.

  • Leverage historical data to understand financial and operational risks.
  • Identify individuals posing high risk for payment variation impacting reimbursements.
  • Continuously manage high-variance DRGs to maintain neutrality after the transition.
  • Collaborate with trading partners to improve predictability of reimbursement.
  • Utilize our interactive executive dashboards or our professionals for program assistance.

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Operating Rules I-IV conformance

No matter where you are on the journey to CORE Operating Rules compliance, Edifecs has a solution that will accelerate your readiness and prepare you for on-going compliance.

  • Identify gaps and recommend remediation steps for all phases of Operating Rules.
  • Perform HIPAA, CORE, and partner-specific validations of data transactions.
  • Track compliance with web-based dashboards to avoid penalties and support calls.
  • Streamlines data exchange with full integration with existing workflows.
  • Utilize our free site for CAQH CORE compliance conformance testing.

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Collaborative and enterprise testing frameworks

Solutions for both internal and external testing, Edifecs simplifies the testing process by reusing transactions as well as seed data as well as clinical scenarios to decrease the overall organizational cost of testing compared to home grown solutions.

  • Enterprise testing reduces cost, increases coverage and provides visibility to results.
  • Collaborative testing framework and methodology for testing with external entities for various mandates and for onboarding new partners.
  • Leverages your own de-identified test data as a corporate asset for reusable testing.
  • Test for mandates, conversions, new lines of business, contract changes, and migrations.

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