JSON twin: https://www.healthaidb.com/software/edifecs.json
Edifecs
https://www.edifecs.com/healthcare-cloud
Edifecs provides a cloud-native healthcare interoperability and operations platform that enables payers, providers, and government agencies to exchange, normalize, and act on clinical and financial data (EDI + FHIR) and to run modular SaaS applications for risk adjustment, prior authorization, encounter/claims management, and value-based payment.
Edifecs is a commercial, cloud-native interoperability and healthcare operations platform offering EDI and FHIR gateways, a smart trading/transaction platform, integration engine, and modular SaaS applications (risk adjustment clinical and coding suites, prior authorization, enrollment/encounter management, member consent, population payment management). The platform focuses on data normalization, routing, validation, enrichment, and workflow automation to support payers, providers and government compliance (including CMS mandates) and value-based care initiatives.
yes
1996
P0508
2025-09-07
commercial proprietary
Commercial enterprise pricing; contact vendor for quotes, tiers, and trial information.
enterprise_quote
1996
product
1.0
{
"company_name": "Edifecs",
"company_url": "https://www.edifecs.com",
"company_offices": [
"United States",
"India"
],
"company_founding": "1996",
"product_url": "https://www.edifecs.com/healthcare-cloud",
"categories": [
"interoperability",
"administrative",
"value-based care",
"risk adjustment",
"clinical analytics"
],
"market_segment": [
"enterprise"
],
"links": [
"https://www.edifecs.com",
"https://www.edifecs.com/who-we-are",
"https://www.edifecs.com/healthcare-cloud",
"https://www.edifecs.com/healthcare-interoperability-cloud",
"https://www.edifecs.com/products/edi-gateway",
"https://www.edifecs.com/solutions/fhir-gateway",
"https://www.edifecs.com/newsroom",
"https://www.edifecs.com/privacy-notice",
"https://www.nctracks.nc.gov/content/dam/jcr:36c968e1-2063-41e0-b194-9fecb2eab160/LME%20MCO%20Manual%20for%20Encounter%20Data%20Submission%20v4%2006012022.pdf",
"https://www.in.gov/medicaid/providers/files/837p-health-care-claim-professional-transaction.pdf"
],
"summary": "Edifecs provides a cloud-native healthcare interoperability and operations platform that enables payers, providers, and government agencies to exchange, normalize, and act on clinical and financial data (EDI + FHIR) and to run modular SaaS applications for risk adjustment, prior authorization, encounter/claims management, and value-based payment.",
"description": "Edifecs is a commercial, cloud-native interoperability and healthcare operations platform offering EDI and FHIR gateways, a smart trading/transaction platform, integration engine, and modular SaaS applications (risk adjustment clinical and coding suites, prior authorization, enrollment/encounter management, member consent, population payment management). The platform focuses on data normalization, routing, validation, enrichment, and workflow automation to support payers, providers and government compliance (including CMS mandates) and value-based care initiatives.",
"target_users": [
"health plan administrators",
"payers",
"managed care organizations (MCOs)",
"provider organizations",
"care managers",
"revenue cycle / claims operations",
"risk-adjustment coders",
"IT/integration engineers",
"government agencies"
],
"specialties": [
"interoperability (EDI & FHIR)",
"claims / encounter management",
"risk adjustment (clinical & coding)",
"prior authorization",
"enrollment management",
"value-based payment / population payment",
"integration engine / message routing",
"data normalization & validation",
"transaction management"
],
"regions_available": [
"United States"
],
"languages_supported": [
"English"
],
"pricing_model": "enterprise_quote",
"pricing_details": "Commercial enterprise pricing; contact vendor for quotes, tiers, and trial information.",
"license": "commercial proprietary",
"deployment_model": [
"SaaS",
"cloud",
"on_prem",
"hybrid"
],
"os_platforms": [
"Web"
],
"features": [
"EDI Gateway (transaction management, X12/EDI processing)",
"FHIR Gateway / FHIR APIs",
"Smart Trading Platform (partner/onboarding, trading partner management)",
"Integration Engine (XEngine Connect)",
"Bi-directional data exchange",
"Transaction specifications / SpecBuilder",
"Encounter Submissions",
"Enrollment Management (ACA, Group, Managed Medicaid, Medicare Advantage)",
"Member Consent Management",
"Prior Authorization (FHIR-based APIs for PA workflows)",
"Risk Adjustment (Clinical Suite and Coding Suite)",
"Value-Based Payment & Insight / Population Payment Management",
"Cloud Member App",
"CMS-0057-F / CMS interoperability support",
"AI-powered analytics and embedded insights",
"Automatic deployment of updates/evergreen compliance",
"Data consolidation, enrichment and orchestration"
],
"optional_modules": [
"Cloud Member App",
"CMS-0057-F module",
"Risk Adjustment Clinical Suite",
"Risk Adjustment Coding Suite",
"Enrollment submodules (ACA Marketplace, Group, Managed Medicaid, Medicare Advantage)",
"Prior Authorization module",
"Population Payment Management"
],
"integrations": [
"Trading partner networks / payer-to-payer exchange",
"Third-party applications via APIs",
"Industry initiatives: DaVinci implementation guides",
"Industry organizations/connectivity: CAQH, Sequoia Project, WEDI",
"Standards bodies/interfaces: ASC X12, NCPDP"
],
"data_standards": [
"FHIR",
"HL7 (v2)",
"X12 / EDI",
"NCPDP",
"DaVinci implementation guides"
],
"api_available": "yes",
"system_requirements": "",
"compliance": [
"HIPAA",
"CMS interoperability mandates (e.g., CMS-0057-F)"
],
"certifications": [
"Best in KLAS: CMS Interoperability - 2024"
],
"security_features": [
"OAuth / OAuth server for API security",
"SSO support",
"Audit logging",
"Encryption (in transit and at rest implied)"
],
"privacy_features": [
""
],
"data_residency": "",
"customers": [],
"user_reviews": [
"Most professional HIPAA-specific validators, like Tibco Foresight and Edifecs, also run locally but are costly.",
"It's an edifecs product called 'Transaction Management'.",
"The EDI integration has been so frustrating. The entire process (gathering requirements, mapping, testing) has been wearing me out since I'm the only one...",
"I would not recommend Edifecs. And feel working there set ... (employee review noted management issues and low care for career paths)."
],
"ratings": [
"KLAS Research: Edifecs Software 78.9 (Overall Score)",
"Glassdoor: ~3.9/5 (employee reviews aggregate)",
"Great Place To Work: Certified; 88% of employees say it's a great place to work"
],
"support_channels": [
"email",
"phone",
"chat",
"ticketing",
"community"
],
"training_options": [
"documentation",
"webinars",
"live_online",
"onsite",
"certification"
],
"release_year": "1996",
"integration_partners": [
"HealthEdge",
"Cotiviti",
"WEDI",
"Tibco (mentioned in community comparisons)"
],
"id": "P0508",
"slug": "edifecs",
"type": "product",
"version": "1.0",
"last_updated": "2025-09-07",
"links_json": {
"self": "https://www.healthaidb.com/software/edifecs.json"
}
}