Government Agencies

Manage costs, improve data quality and access while achieving ongoing compliance and trading partner satisfaction

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Enable modular data quality and payment reform solutions

Managing a continually increasing flow of data in a complex regulatory landscape can create logistical and operational challenges that are costly and resource intensive. Edifecs solutions can help you streamline and scale your data securely to better enable your Triple Aim efforts and ongoing compliance.

Infographic - Government Agencies


EDI as a Service

Moving your EDI capabilities from on-premise to SaaS is akin to moving from an analog flip phone to a smartphone – the possibilities are endless. Adopting a SaaS model for your EDI brings better security and ease of access, not to mention:

  • No more upgrades or waiting for infrastructure
  • Eliminates the need to specify data formats
  • Ongoing and automated compliance with existing and evolving mandates

Improve the security and scalability of your EDI with a SaaS model

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Value-Based Exchange

Gain transparency and insights to support end-to-end contracting and administration of value-based arrangements from joint design to deployment, including continuous monitoring, program optimization, and rapid scaling.

  • Single point of data submissions for all providers
  • One platform to support all value-based care models
  • Analytics for state Medicaid agencies to view level of activity and taxpayer dollar savings
  • What-if analysis and actionable insights for providers to help drive desired outcomes
  • Trusted, higher quality data with advanced data processing, analytic, and reporting capabilities

Empower and enable the adoption of value-based payment models with your MCOs and provider community

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Healthcare Data Interoperability

Enable continuous compliance with CMS FHIR® mandates. Streamline and standardize the exchange of clinical and financial data between payers and providers for real-time interoperability and compliance using FHIR® APIs.

  • Jump-start your FHIR® development using the EDI Smart Trading platform
  • Share FHIR® information with developers, members, and third parties
  • Deploy interoperability solutions developed by professionals with nearly 50 implementations and 26 years of proven expertise in data exchange

Reduce administrative and infrastructure costs while ensuring ongoing compliance with interoperability mandates

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Enrollment Management

Improve the quality and timeliness of delivery of Marketplace enrollments to carriers by automating manual processes with our modern, centralized enrollment platform. The platform orchestrates data streams for your Marketplace and ensures lower cost and tighter integration with Carriers. Gain new visibility, operational efficiencies, and faster processing times.

  • Reduce the cost of manual intervention and processing with intelligent workflows and automation, resulting in lower costs and fewer data errors
  • Enable self-service capabilities for carriers' maintenance, corrections, and audit discrepancy reviews
  • Automate upfront data validation and system-wide orchestration

Support State Marketplaces through a modern orchestration layer for expedited process and delivery to carriers

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