Breakdown operational barriers to scale and drive strategic growth while securing revenue streams.
Health plans have been forced to purchase redundant software platforms to manage related operational areas because of data and process silos. Edifecs Revenue Growth solutions improve encounter management and member enrollment efficiency and accuracy to reduce costs and ensure revenue for Medicare Advantage, managed Medicaid, dual eligible and Marketplace programs in conjunction with standard commercial plan offerings.
Edifecs ensures health plan revenue accuracy by consolidating and automating enrollment, encounter management and risk adjustment operations. We protect plan revenue streams and drive competitive differentiation through scalable solutions for both commercial and government programs.
Edifecs enables PBMs to decrease encounter and enrollment data management cost and complexity. Through Edifecs, PBMs can reduce IT burden, mitigate health plan abrasion and ensure differentiation in a highly competitive market.
Edifecs ensures that member enrollments and updates from health plans are processed seamlessly and accurately ensuring no loss of revenue.
Edifecs provides ease of integration and accuracy between state eligibility records and encounter data submissions with partner health plans.