Commonwealth of Pennsylvania Partners with Edifecs to Provide EDI Module Services

First of its kind EDI focused module in compliance with 2020 MMIS Platform Project Certification

BELLEVUE, Wash.--()--Edifecs, Inc., a global health information technology solutions company, announced that it has been selected by the Department of Human Services of the Commonwealth of Pennsylvania to implement its purpose-built electronic data interchange (EDI) solution. Edifecs’ EDI Module for State Medicaid Agencies will help the Commonwealth modernize and achieve the Medicaid Management Information Systems (MMIS) 2020 Platform vision of Timely, Accurate, Complete, Outcomes (TACO).

As part of a larger effort to streamline the EDI format – away from the traditional approach to MMIS modularity, which assumes multiple, disjointed EDI processing capabilities are embedded in separate systems - the partnership will allow the Commonwealth of Pennsylvania to leverage an EDI exchange layer that is independent from the MMIS value chain - increasing the state’s ability to rapidly adopt new operating models while reducing administrative burden and operational risk.

The cloud-based Edifecs EDI Module for State Medicaid Agencies provides the connectivity, trading partner management and compliance with data quality standards, including HIPAA and Committee on Operating Rules for Information Exchange (CAQH CORE), required for MMIS Platform certification. Together, this enables timely EDI processes, increases overall accuracy and completeness of data and continuous improvement of outcomes

“As the Commonwealth of Pennsylvania and states across the country work to achieve certification with the next generation MMIS platforms, Edifecs is committed to helping Medicaid agencies streamline their electronic data interface formats,” said Sunny Singh, president and CEO, Edifecs. “As the leader in Medicaid EDI and interoperability, Edifecs’ agile platform brings together the necessary stakeholders, systems and data to ensure the state health plans can navigate healthcare’s evolving data standards and address data quality improvement goals.”

This implementation will support business outcomes for the Department of Human Services of the Commonwealth of Pennsylvania including:

  • Collaborate and cooperate with the MMIS 2020 Platform and stakeholders to coordinate system implementation, changes, modifications and scheduled maintenance for the EDI Module.
  • Achievement of the Centers for Medicare and Medicaid Services (CMS) certification for the EDI Module and operations continuity with the MMIS 2020 Platform post-implementation.
  • Assurance that EDI services provide high service availability and uptime.
  • Achievement of the Secure Council for Affordable Quality Healthcare, Inc. and CAQH CORE certifications.
  • Conform in accordance with CMS’ goal of a loosely coupled service-oriented architecture through collaboration with multiple contractors responsible for providing and supporting separate modular solutions.
  • Implement all inbound and outbound state required HIPAA X12 and National Council for Prescription Drug Programs (NCPDP) transactions with the ability to accommodate future interoperability mandates in a single solution.

For more than 20 years, Edifecs’ suite of data exchange technology has equipped health plans, providers, government agencies and ACOs with solutions that enable scalable interoperability, assuring compliance, correlating clinical and administrative data and delivering real-time visibility of each partner data exchange.

For more information about Edifecs and its work with small and medium sized health plans, visit:

About Edifecs

Edifecs develops innovative, cost-cutting information technology solutions to transform the global healthcare marketplace. Since 1996, Edifecs technology has helped healthcare providers, insurers, pharmacy benefit management companies and other trading partners trim waste, reduce costs and increase revenues. More than 350 healthcare customers today use Edifecs solutions to simplify and unify financial and clinical transactions. In addition, Edifecs develops supply chain management solutions to support worldwide customers in non-healthcare industry segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at


Janet Hohmann


Janet Hohmann