Tap our deep industry knowledge, strategic services and world-class support

We’ll help you shape an overall strategy to accelerate reform adoption, reduce your operating costs, and lock-in predictable results

Strategic Advisory Services

With more than 20 years’ experience in the payer, provider, pharmacy and government industries, Edifecs Strategic Advisory Services (SAS) provides healthcare organizations with deep expertise across business, operations and IT. Our innovative payer-provider solutions helps provide a competitive advantage by reducing unnecessary medical, administrative and IT costs. To date, 47 Blues plans, 50 commercial plans, 70 provider organizations, and 60 percent of US Medicaid recipients have benefited from our deep healthcare expertise.

Providing you a competitive advantage

Edifecs delivers long-term, meaningful services to our customers. We combine deep industry expertise (Business, Operations and IT) with strong consulting capabilities. This powerful combination enables you to meet your business and organizational objectives, and all required mandates, while you maximize operational effectiveness to reduce your costs.
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Service Offerings

Clinical

Integrate Health Management with Clinical Data Exchange
Enable Accountable Care Models

Financial

Define ACO Contracts and Performance
Implement Best in Class Encounter Management Strategies
Ensure Revenue Integrity with Risk Adjustment

Smart Trading

Define Best in Class Payer EDI Operations
Improve Customer Experience and MTM Scores

Consumer

Define Member 360° Needs for Retail Enablement
Streamline Exchange Enrollment and Subsidies

Compliance

Define Duals Readiness and Compliance
Operating Rules Compliance Readiness
ICD-10 Health Check and Readiness