Unified Operations

Unified Operations by Edifecs is a solution designed to unify, normalize, and exchange clinical and financial data in the healthcare industry. According to the vendor, this platform aims to automate business processes, modernize technical infrastructure, and reduce costs for companies in the healthcare industry, including health plans, healthcare providers, government agencies, and other industries.

Key Features

Enrollment Management: According to the vendor, this feature aims to consolidate, automate, and expedite enrollment operations across lines of business. It includes streamlining file intake and validation processes, delivering collaborative toolsets for brokers and customers, implementing intelligent workflows for discrepancy resolution, and enhancing partner satisfaction with streamlined operations.

ACA Marketplace: The vendor states that this feature optimizes ACA plan enrollment operations, ensures marketplace regulatory compliance, improves financial reconciliation processes, automates coverage updates and discrepancy resolution, and enables lifecycle visibility for better administration.

Group Enrollment: The vendor claims that this feature improves group enrollment satisfaction and performance by streamlining file intake processes, delivering collaborative toolsets for brokers and groups, implementing intelligent workflows for discrepancy resolution, and enhancing partner satisfaction with streamlined operations.

Managed Medicaid: According to the vendor, this feature allows users to easily handle state-specific nuances in enrollment systems. It includes implementing inbound data centralization for improved data quality, deploying intelligent workflows for discrepancy resolution, accelerating upfront discrepancy identification, and improving financial reconciliation processes.

Medicare Advantage: The vendor claims that this feature accelerates eligibility processing with automated workflows, solidifies CMS integrations for compliance, improves member correspondence generation for prompt and compliant communication, accommodates downstream system integration for seamless data exchange, and enables lifecycle visibility for better administration.

Healthcare Compliance: According to the vendor, this feature ensures ongoing compliance with healthcare operating rules. It leverages FHIR APIs for strategic interoperability, provides a member app for enhanced consumer engagement, implements payer to payer data exchange for seamless data sharing, and enables patient cost transparency for improved healthcare decision-making.

Healthcare Data Interoperability: The vendor states that this feature enables real-time data sharing across the healthcare ecosystem. It allows for bi-directional data exchange, leverages FHIR APIs for strategic interoperability, implements payer to payer data exchange for seamless data sharing, and enables automated prior authorization for streamlined processes.

HIT Administrative Simplification: According to the vendor, this feature automates business processes and reduces costs. It ensures compliance with evolving legislation, improves scalability and performance of IT investments, reduces friction, and increases transparency between stakeholders, aiming to enable a more efficient and connected healthcare experience.

Bi-Directional Data Exchange: The vendor claims that this feature enables automated exchange of data between different systems, improving interoperability and data sharing across healthcare organizations. It aims to reduce manual data entry and potential errors.

Encounter Submissions: According to the vendor, this feature streamlines the submission of encounter data to regulatory agencies. It ensures compliance with CMS and State-specific guidelines, reducing errors and improving accuracy in encounter data reporting.