Accelerate Administrative Simplification

Enable EDI Modernization and Cost Reductions

EDI Modernization

There is significant pressure on State Medicaid Agencies (SMAs) to automate business processes and scale infrastructure, meet industry-wide and legislative requirements, and lower overall costs. All while adhering to healthcare regulations and processes (e.g. HIPAA, HITECH, ICD-10, CAQH CORE, state initiatives and clinical/administrative data integration).

Our Solution

All post-reform healthcare initiatives require a modular, out of the box, compliant data exchange solution. Edifecs Smart Trading dramatically reduces the infrastructure and administrative costs for SMAs. The solution supports cross-platform / format interoperability and delivers industry-leading visibility into transactions and member activity.

Capabilities

Unmatched quality, performance and throughput for transaction processing

Leverage the industry-leading transactional processing platform including FHIR support for clinical data.

 

  • Minimize processing delays, reduces integration challenges and increases first-pass rates.
  • In-stream processing allows transaction validation against standards (HIPAA/EDI, HL7, NCPDP, etc.).
  • Data enriched through  lookups, code set verifications (ICD-10), and business rules increase the integrity of partner exchanges.
  • Run-time configuration integration through the Smart Trading Cloud Repository.

Utilize the gold standard in design-time tools

Deploy a simple and easy to use library of over 30,000 specifications and code sets (HIPAA 5010, HL7, CCD, ICD10, NCPDP).

 

  • Author, validate and publish specifications including out of the box support for WEDI SNIP levels 1-7.
  • Relax or tighten business rules using the integrated environment to test specifications and publish automatically.
  • Build a foundation for data liquidity for all lines of business and multiple downstream applications.
  • Reduce the time, cost and complexity of connecting and exchanging data.

Operationalize industry-leading transactional insight

Gain new visibility into encounters, claims and clinical care in one integrated, time-sequenced view.

 

  • Understand the context of the event and message to make an informed decision.
  • Organize and correlate partner interactions and related messages.
  • Deliver trend reports and rich search functions – including keyword searches.
  • Reduce hours of research to minutes with multipurpose dashboard.

Enable cross enterprise claims attachments

Enable cross enterprise claims attachments.

 

  • Aggregate medical documentation across all channels and intelligently route them to back-end systems.
  • Support for "safe harbor" 277/275 EDI transactions and future standards (FHIR)
  • Ensuring operational efficiency through end-to-end tracking and transparency.
  • Drive provider adoption with multiple low cost avenues for file exchange.
  • Visibility and clarity into cross-enterprise medical attachment workflows.