Edifecs

Edifecs is a leading healthcare technology company delivering next-generation solutions that streamline administrative processes, strengthen data interoperability, and improve financial and operational performance across the healthcare ecosystem. For more than 25 years, Edifecs has empowered health plans, providers, government agencies, and employers with innovative tools designed to modernize healthcare operations and enhance the member and patient experience.

Trusted by many of the nation’s largest Medicaid and commercial health plans, Edifecs specializes in interoperability, prior authorization, data exchange, payment integrity, encounter management, and analytics. The company’s platforms are built to reduce administrative burden, increase accuracy, and accelerate value-based care transformation by ensuring seamless, real-time data flows between stakeholders.

Key capabilities include:

• Automated Prior Authorization and clinical data retrieval
• Interoperability solutions supporting CMS, ONC, and state regulatory requirements
• FHIR®-based data exchange and standardized APIs
• Payment integrity and cost containment tools
• Encounter and claims data management
• Advanced analytics supporting quality, compliance, and population health

Edifecs brings deep expertise in Medicaid modernization, enabling states and managed care organizations to meet evolving federal mandates while improving program integrity and operational efficiency. Their scalable, cloud-based solutions empower agencies and health plans to optimize processes, strengthen accountability, and deliver better outcomes for members.

Headquartered in Bellevue, Washington, with offices across North America and abroad, Edifecs is widely recognized as a trusted technology partner driving interoperability, innovation, and digital transformation across the healthcare industry.