Comply with mandates

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Compliance Solutions

Manage the compliance lifecycle of administrative simplification mandates that govern healthcare partnerships. Reduce the risk and cost of compliance mandates with Edifecs Compliance solutions.

Foundation for Value-Based Care

Investments in ICD-10 coding provides new insights and delivers the transparency necessary to develop clinically relevant cohorts in population health management. CAQH CORE Operating Rules have piloted near real-time conversations for eligibility and improved care coordination to transition to pay-for-performance.

Mitigate the impact of healthcare mandates from HHS, CMS or State Medicaid Agencies (Meaningful Use, ICD-10, CAQH CORE Operating Rules). Use Edifecs industry leading practices to assess, remediate, test, verify and monitor programs.

Initiative and Value Proposition

$2.58 savings per claim1

Reduce Administrative Costs

Reduce claims pre-processing costs.

Reduce manual adjudication.

Reduce partner onboarding costs.

Reduce EDI transaction costs.

$0.54 savings per electronic transaction2

Reduce IT Total Cost of Ownership

Consolidate administrative and clinical trading infrastructure.

Reduce the cost of change through configurability.

These values are based on CAQH’s 2014 Index report and analysis. Contact our experts to determine your value proposition.

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  • CS

    Case Study

    Voice of Customer

    “MHDC’s partnership with the Massachusetts eHealth Collaborative and Edifecs provides plans and providers a complete testing solution that balances collaboration and confidentiality to minimize the technical, operational, and financial risks of ICD-10.”

    Denny Brennan, Executive Director, Massachusetts  Health Data Consortium

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  • CS

    Case Study

    Voice of Customer

    “This testing portal is so powerful and easy to use that it will be a no-brainer decision for teams to source test data from us versus creating it the hard way.”

    Brad Green, Test Data Manager, Enterprise QA & Testing Services, BCBSMA Information Technology

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Solution Spotlight

  • ICD-10 Solutions

    Are you one of the 72% of organizations that hasn’t performed any revenue impact testing? Are you relying solely on their clearinghouse for ICD-10 transition testing. Ensure your success with Edifecs product offers and professional service by correctly mapping ICD-10 codes early, identifying and address areas of highest risk, and transition smoothly with post transition analytics. These insights will help guide the way to future strategies and healthier populations.

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  • Operating Rules

    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 ongoing service level maintenance with current and future phases of CORE.

    Edifecs has provided the CORE certification testing portal for free–available 24/7/365 and our expert staff have helped over 150 organizations achieve CORE certifications. How can we help you?

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  • Enterprise Testing

    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 ongoing service level maintenance with current and future phases of CORE.

    Edifecs has provided the CORE certification testing portal for free–available 24/7/365 and our expert staff have helped over 150 organizations achieve CORE certifications. How can we help you?

    Learn more

Capabilities

More efficient transactions perpetually reduce operating expenses. Mandates like CAQH CORE Operating Rules, ICD-10, and others, lay important groundwork that standardizes trading of administrative and clinical data.

For nearly two decades Edifecs has helped payers, providers and states accelerate their projects, maximize interoperability and simplify administrative processes. Key points:

  • Industry leader and only CAQH/CORE certification.
  • Address the full lifecycle for mandates.
  • Full visibility for pre and post-transition


 

Compliance Lifecycle

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

 

Administrative Simplification Enabled

Operating Rules

Operating Rules: Phases I-III begin enforcement; Phases IV and beyond with major opportunities around claim attachments and referral and pre-authorizations

Partner Management

Operating agreements of large consortiums (enforcement, testing and transactional infrastructure)

Enterprise Testing

Notice of Proposed Rule Making: government understands the need for more streamlining around interoperability and testing

Transitions

Meaningful Use: require testing when new systems are launched, upgraded or roll out new phases

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