Edifecs Introduces Healthcare Interoperability Cloud

Edifecs FHIR and EDI Solutions, Foundational for Strategic Interoperability and CMS-0057-F Compliance, Named Leaders in Independent Payer Market Study

BELLEVUE, Wash.--(BUSINESS WIRE)--Edifecs, Inc., a global health information technology solutions company, today announced its Healthcare Interoperability Cloud, which enables payers to take a strategic approach to interoperability and address compliance, including with CMS-9115-F and CMS-0057-F, and non-compliance use cases. In a recent study of 99 payers by a leading third-party consultant, Edifecs was identified as the leading partner for both FHIR® and EDI solutions – uniquely positioning Edifecs as the preferred provider of strategic interoperability capabilities for healthcare payers. Since its inception in 1996, Edifecs has been integral in defining the standards that guide and govern interoperability.

“Spurred by government mandates, economic pressure, and the continued pursuit of better patient outcomes, the healthcare industry is prioritizing interoperability as a critical foundation for transformation. In January McKinsey reported that rapid growth will continue in advanced technology-based segments. We increasingly see customers embracing interoperability as a core component of their digital health strategies, enabling scale, extensibility, and agility in the face of evolving use cases,” said Chris Lance, chief product officer, Edifecs. “By helping our customers define and execute on holistic strategies for interoperability rather than narrow one-off use cases, we are extending the utility and value of their existing infrastructure while enabling new levels and modes of information sharing and transparency across departments, business processes, and organizations. This directly benefits health plans, their partners, and ultimately the members who depend on them.”

Edifecs Healthcare Interoperability Cloud enables a strategic approach to interoperability by combining a comprehensive healthcare data management and interoperability platform with the company’s industry-leading unified payer gateway to facilitate the seamless exchange of administrative and clinical data in any format, including EDI, FHIR, NCPDP, and HL7v2, as well as any proprietary format. This enables customers to seamlessly connect systems, processes, organizations, and people across the entire healthcare ecosystem, automating shared workflows, fostering collaboration, and ensuring long-term compliance with market and legislative demands. Edifecs solutions can be deployed alongside other complementary technologies to deliver greater ROI and surface better insights, faster. The award-winning solution is featured in the 2024 Fierce Healthcare Innovation Report.

“The future of healthcare hinges on collaboration. This requires transparent, trust-based platforms that enable stakeholders to work from a comprehensive shared data set,” Lance said. “Regardless of mandates or rules, the only way to tackle administrative waste, reduce the burden of prior authorization, and deliver on true price transparency is through better and deeper information exchange. Edifecs technologies have the capabilities required to power meaningful progress by enabling these critical interactions.”

As a leader in industry standards, Edifecs is focused on pioneering and adopting open standards that enable solutions payers, providers, and government agencies need to help them navigate the fractured data landscape and deploy a connected, collaborative, and outcomes-based healthcare system. In December of 2024, Edifecs became a member of the Sequoia Project, participating in several workgroups chartered with improving interoperability and reducing barriers to collaboration between payers and their provider partners. Edifecs remains an active participant and regular contributor to established industry-standards groups including as a founding member of HL7’s FHIR accelerators Da Vinci Project and the FHIR at Scale Taskforce (FAST) as well as CAQH and the Workgroup for Electronic Data Interchange (WEDI), where the company holds a board seat.

About Edifecs

Edifecs provides market-leading technology to its 300+ payer and health system customers, who serve nearly 300 million people in the U.S. healthcare market. For over 25 years, Edifecs has enabled customers to transform by unlocking greater value with their healthcare interoperability and data management, workflow and operations solutions, which includes its award-winning Healthcare Interoperability Cloud solution. Edifecs’ healthcare SaaS solutions, available via public, private, and hybrid clouds, serve as the foundation to help eliminate stakeholder friction and overcome healthcare’s biggest challenges, including accelerating value-based payment adoption and obtaining more complete and accurate care funding for alternative payment models. Edifecs’ solutions are powered by AI that incorporates generative AI and LLMs, natural language processing, and machine learning, to provide deeper insights into patients, populations, and business processes. As new standards and regulations continually emerge from government agencies, Edifecs is a proven partner to support its customers road to “evergreen” compliance. Edifecs customers include 24 of the 25 top commercial health plans in the country, 32 of the 51 Medicaid programs, and 6 out of 10 of the largest health systems.