We’ll help you secure market growth and manage revenue streams across lines of business
Edifecs ensures health plan revenue integrity 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.
We enable PBMs to decrease encounter submission cost and complexity. Through Edifecs, PBMs can reduce IT burden, mitigate health plan abrasion and ensure competitive differentiation in a highly competitive market.
Accurate, complete and timely encounter submissions are vital to accurate risk-adjusted payments and regulatory compliance in government and commercial programs. Pharmacy benefit management companies (PBMs) must reduce health plan abrasion and drive competitive differentiation. Learn how to proactively navigate these challenges, streamline program complexity and reduce costs even in the face of change.
Edifecs Enrollment Management standardizes and validates enrollment intake across channels. Configurable business rules trigger system-driven updates to downstream systems of record. Now users can modernize enrollment channels while standardizing intake—without costly changes to core systems. This is a speed-to-market advantage for your new products and services.
The Edifecs Health Insurance Exchange solution delivers seamless connectivity with a wide range of state, federal Marketplaces and thrd-party systems, enabling health plans to launch and operate in multiple envirnments. Health plans can maintain integration, stay up-to-date with changing mandates and industry data exchange standards and enhance scalability without the complexity and cost of point-to-point system integrations
Edifecs Risk Adjustment drives powerful, precise, real-time risk score analytics at both the population and member level. Enable effective interventions while closing coding and care gaps. Integrated with Edifecs Encounter Management for comprehensive risk-adjusted program management. Establish robust internal audit programs and prepare for external audits.
Accurate, complete and timely encounter and Edge Server submissions are vital to accurate risk-adjusted payments and regulatory compliance in government and commercial programs.
For health plans, growing and enhancing their Marketplace and private exchange lines of business require seamless, secure connectivity.
Accurate health plan revenue for Marketplace, managed Medicaid, Medicare Advantage and Dual Eligible programs rely on accurate and insightful risk adjustment analytics.
New and expanding enrollment channels for health plans require standardized and integrated intake capabilities across lines of business.