Edifecs for SMB

Edifecs offers best in class Smart Trading and Encounter Management solutions tailored specifically for small and mid-sized health plans.

Edifecs for SMB

Now more than ever before, growing health plans need nimble, efficient data integration and encounter management optimization. Edifecs understands these needs and has leveraged our 20+ years experience and rich payer knowledge to craft solutions specifically designed to meet the unique challenges of SMB payers.

Our Solutions

Edifecs SMB solutions are catered to meet the unique needs of small and medium size payers. Instead of going through a complicated and lengthy solutioning process, Edifecs knows exactly what you need and what you don’t need, and we come to the table with those solutions pre-packaged. This expedites the procurement process, reduces implementation time, and eliminates erroneous features that aren’t applicable to your business, resulting in a cost effective solution that meets all your encounter management and trading needs.

Smart Trading for SMB

  • Pre-built library of all major healthcare standards
  • Identification of process anomalies and rejection monitoring
  • Easily connect to all partners and collect every type of data to automate processes and reduce costs
  • Increase auto-adjudication rates and reduce pends with up-front code checks and claim clinical edits 
  • Upfront error notifications to partners detailing data that was accepted or rejected and why
  • Proactive alerts to uncover issues before they are evident to partners

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Encounter Management for SMB

  • Assurance that the most revenue-impactful encounters are corrected and re-submitted through prioritized exception management workflows for submission timeliness
  • Built-in business rules and compliance edits to perform validations and ensure accuracy, resulting in first pass acceptance rates surpassing 99 percent
  • Actionable dashboards to drive the highest possible submission completeness and accuracy
  • Consolidation of encounter operations for both Medicare Advantage and managed Medicaid programs in a single system
  • Comprehensive claim-to-encounter lifecycle tracking

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Who We Help

Health Plans

Edifecs simplifies data ingestion and consolidates any data source including complex clinical systems to reduce administrative costs, automate processes, and ensure compliance.


Edifecs has solutions to simplify the start-up and rapid growth of provider-sponsored health plans. From complex data needs to encounter management, Edifecs provides a flexible architecture that can meet these needs across all lines of business.