AI/NLP for Real-Time Prior Authorization for Payers & Providers
Prior authorization is one of the last unautomated business processes. That’s all about to change now that technology has evolved to a point of being an effective change agent that can solve for prior authorization like never before. By leveraging AI/NLP, FHIR® standards, and EHR integration, the path to real-time automated prior authorization from the provider’s EHR to the payer’s utilization management is finally within grasp.
Data Sheet

Overcoming Marketplace Open Enrollment Challenges
Is your health plan too bogged down dealing with legacy enrollment platforms to pursue strategic initiatives? We unearthed common challenges plans face while participating in public exchanges

One Plan's Secret to ACA Success
As a participant in the ACA Marketplace since its inception, a large North Carolina-based health plan had seen it all…the turbulent roll out, competitors coming and going (and then returning), and a resurgence driven by the current administration as well as the pandemic.
Case Study

CAQH CORE Users – Phase IV Quick Start V-1.3
User Quick Start Guide For the Edifecs Healthcare Claims/Benefit Enrollment/Premium Payment/Prior Authorization & Referrals (CAQH CORE Infrastructure Rules) CAQH CORE Certification Testing System
Solution Brief

Harness Healthcare Data to Drive Encounter Visibility
A 3-Part series giving information about Solving MSO Business Problems , Modernizing the EDI Front-End to Ensure Up-Front Data Compliance & Visibility and Using Best-in-Class Encounter Management to Drive Revenue Accuracy

Beyond the Encounter: Connecting the Data Dots Beyond Encounter Submission
It’s no secret managed care plans generate mountains of health data. Yet much of this data is stuck in disconnected siloes…both inside and outside the four walls of a plan. For today’s health plans, this is no longer acceptable. Regardless whether the need is to comply with new CMS mandates, enhance risk-adjusted revenue accuracy or both, disconnected data must become a thing of the past.

Maryland Encounter Data Submission Made Easy
Edifecs, the market leader in encounter management, has developed an encounter submission module just for the state of Maryland. With the required formats, rules, companion guides, etc…already included, it’s encounter data submission made easy.

Solving for Texas Encounter Compliance
Overcoming Texas encounter submission roadblocks requires teaming up with an experienced partner with deep state-specific knowledge and best-in-class technology solutions.

Streamlining Supplier EDI Onboarding
Self-service EDI integration with Edifecs Ramp Management reduces supplier integration costs and dramatically increases the number of suppliers onboarded each month. Edifecs Ramp Management delivers 60% reduction in FTEs required to onboard a supplier and 75% increase in suppliers added per month.
Case Study