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Operating Rules

Regulatory mandates require health plans to comply with certain operating rules for administrative simplification—and plans can incur significant financial penalties for noncompliance.

Edifecs Operating Rules is the comprehensive solution health plans need to meet and stay compliant with regulatory requirements and manage transaction workflows across all phases. And as a designated CAQH Vendor of Choice for Operating Rules certification, our comprehensive framework is the only solution authorized for CAQH CORE certification.


Enable and Maintain Compliance With Edifecs

Learn how Edifecs can support all your healthcare data needs.

Healthcare Interoperability 1
assess
  • Ensure your organization is ready for implementation
  • Spot and address performance gaps before they become an issue
  • Highlight critical tasks that can affect implementation success

Improve workflow efficiency

Identify and remediate gaps before and during implementation of Operating Rules.

Patient Data Management 2
test
  • Perform production-level testing
  • Ensure CORE certification by preemptively identifying gaps that might otherwise go overlooked
  • Avoid preventable errors by leveraging extensive test case data

Implement with confidence

Minimize errors by simulating real trading partner interactions before implementation.

FHIR Edifecs 3
track
  • Access executive-level dashboards for a snapshot of overall compliance
  • Go deeper with detailed reporting on compliance in specific areas
  • Stay up-to-date with alerts about compliance issues requiring attention

Enable ongoing compliance

Monitor, document, and report on operating rule compliance for timely reviews and peace of mind.


News & Insights

Interoperability Solution with FHIR
A simplified approach to meeting compliance with the CMS Interoperability & Patient Access Final Rule and the ONC 21st Century CURES Act Final Rule
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Payer to Payer Data Exchange
Enable the real-time exchange of data in FHIR format between payers
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Patient Cost Transparency Solution
Empower members in their healthcare decisions
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