Edifecs


Cotiviti + Edifecs

By bringing together Edifecs' industry-leading health data management platform with Cotiviti's advanced technology, data analytics, and specialized expertise, our unified organization will deliver exceptional value to healthcare organizations as they seek to provide better care at lower cost.

Learn More ❯

Powering Intelligent Healthcare Transformation

Healthcare is evolving. So are we.

For over 25 years, Edifecs has been a market leader in healthcare data interchange. Hundreds of health plans, providers, and government agencies rely on our interoperability solutions to unify, normalize, and exchange clinical and financial data. As the healthcare industry has evolved, our solutions have evolved with it. Our cloud-native, AI-powered solutions are designed to help healthcare organizations thrive in value-based care.

Explore the Healthcare Cloud

Who We Serve

Health Plans
Collaborate with providers, automate manual processes, lower costs, and drive incremental revenue with our interoperability platform, value-based payments processing, and workflow solutions.
Learn More  ❯
Healthcare Providers
Thrive in alternative payment model arrangements, reduce administrative burdens, and support care delivery and outcomes with our interoperability platform, risk adjustment, prior authorization, and workflow solutions.
Learn More  ❯
Government Agencies
Apply innovative, modern technology to eliminate administrative, maintenance, and compliance challenges while creating a more equitable care framework.
Learn More  ❯
Other Industries
We help government agencies manage costs, improve data quality and access while achieving ongoing compliance and trading partner satisfaction.
Learn More  ❯

Payers. Providers. Patients. Connected.

Edifecs' interoperability platform and business applications help payers and providers innovate, collaborate, and ultimately deliver better care. It's time to change the game.

Edifecs customers are creating a more connected healthcare industry using our Best in KLAS interoperability platform. We are helping them change the game by providing them the solutions to:


Proven Healthcare Leadership

0+

Leading Health Plans, Providers, and Government Agencies

0+

Years Experience

0M

U.S. Lives Covered by Edifecs Clients


Da Vinci Logo
CAQH Logo
NCPDP Logo
Best in KLAS: CMS Interoperability - 2024
WEDI Logo
Sequoia Project Logo

Opportunity awaits. Are you ready to join the healthcare transformation?

Learn how Edifecs can help you achieve these outcomes.

News & Insights

Supercharging Value-Based Program Growth with Edifecs
Learn how PPM enabled a health plan to grow their value-based contracts by over 1300%.
Learn More  ❯
Optimizing Encounter Operations and Submissions
In this case study, we discuss how Edifecs Encounter Management (EM) helped our customer unify and consolidate their encounter data and achieve cross-product synergy between EM, Edifecs Retrospective Reviews, and even third-party chart retrieval solutions offered by other vendors. The result: A seamless, automated, and integrated system and a 98%+ acceptance rate.
Learn More  ❯
Going Beyond Compliance with Edifecs’ FHIR® Gateway
See how Edifecs’ FHIR Gateway solution helped a health plan not only achieve compliance with CMS-9115-F, but allowed the plan to fully maximize the benefits of implementing FHIR APIs as well.
Learn More  ❯
Provider Perspectives- Interoperability & Patient Data
Provider Perspectives: Interoperability & Patient Data
Managing patient data in an evolving interoperability landscape.
Learn More  ❯
Understanding the Differences Between Risk Adjustment Programs
Understanding the Differences Between Risk Adjustment Programs
How the three most common risk adjustment programs are alike—and how they’re not.
Learn More  ❯