Edifecs interoperability solutions enable compliance with CMS Interoperability and Prior Authorization Final Rule

BELLEVUE, Wash.: Edifecs, Inc., a global health information technology solutions company, announced today that the Edifecs interoperability platform, XEngine Server for FHIR® and EDI, has been named the market leader for CMS Payer Interoperability for the second consecutive year by KLAS Research in its 2024 Best in KLAS: Software & Services report. Edifecs was ranked as the leader among vendors that provide software designed to meet the requirements for CMS-related payer and state agencies by providing patient access API, provider directory API, and payer-to-payer data exchange. Edifecs topped the list with a score of 92.2, surpassing its own market-leading score of 87.9 in 2023.

With nearly three decades of experience innovating at scale, Edifecs is the industry leader in helping hundreds of healthcare organizations achieve ongoing interoperability and compliance. Edifecs’ KLAS-award winning interoperability platform now includes the FHIR API for Prior Authorization and EDI capability required to address all components of the CMS-0057-F mandate. The solution is already available to multiple Edifecs customers, giving them a competitive head start on compliance well in advance of the 2026/2027 deadlines.

The Best in KLAS award furthers Edifecs’ recognition as the market standard for administrative, clinical, and pharmacy interoperability. Additionally, Edifecs is a CMS approved vendor for verifying industry data via its administrative simplification testing tool and the vendor of choice for CAQH for industry operating rules certification.

“We are honored to be recognized by KLAS for the second year in a row in the CMS Payer Interoperability category. Since our inception, Edifecs has been focused on harnessing data—making sure the data is accessible and accurate, distilling meaning from that data, and ensuring it can be shared and applied when and where it is needed,” said Venkat Kavarthapu, CEO, Edifecs. “This deep knowledge makes our platform the proven choice to future-proof capabilities and ease the adoption of new compliance mandates like CMS-0057-F. Our solutions are designed to help successfully manage complexity, increase the ROI of existing core systems, and replace the pervasive friction between payers, providers, and members with collaboration and transparency, enabling the successful adoption of value-based programs. This KLAS award validates our work to catalyze interoperability across the healthcare system.”

Edifecs is uniquely positioned to provide a unified interoperability solution that enables the exchange of any kind of data between partners. Its solution is the gold standard because of its completeness, the richness of its functionality, and the level of support the organization offers. This is a significant differentiator and a major contributor to Edifecs being awarded Best in KLAS for the second year in a row. The Edifecs interoperability platform enables the exchange, unification, and processing of all data including proprietary flat files, healthcare administrative transaction files, pharmacy data, clinical data, and unstructured data. With the Edifecs Cloud, customers are able to increase the ROI of existing IT systems and avoid the costly and disruptive “rip and replace” alternative.

“At KLAS, we firmly believe that the voice of healthcare providers and payers is paramount. The Best in KLAS awards are based on extensive feedback and evaluations from healthcare professionals across the nation. Winning a Best in KLAS award, therefore, is not just about recognition; it shows the trust and confidence that healthcare providers place in the winning vendors. It also helps validate each vendor’s commitment to innovation, quality, and customer satisfaction. We are proud to recognize 2024’s Best in KLAS award winners! Their unwavering dedication to improving patient outcomes is wonderfully inspiring,” said Adam Gale, CEO, KLAS Research.

About Edifecs

Edifecs provides market leading technology to its payer and health system customers, which serve nearly 300 million people in the U.S. healthcare market. For over 25 years, Edifecs has enabled customers to unlock greater value by aggregating, normalizing, and unifying data with its Best in KLAS interoperability platform. The Edifecs platform serves as the foundation for the solutions that eliminate stakeholder friction to 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 incorporate natural language processing, machine learning, and artificial intelligence 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 ensure its customers maintain “evergreen” compliance. Edifecs customers include 24 of the 25 top commercial health plans in the country, 25 out of 36 of the Blue Cross Blue Shield payers, 32 of the 52 Medicaid programs, and 6 out of 10 of the largest health systems.

About KLAS

KLAS is a research and insights firm on a global mission to improve healthcare. Working with thousands of healthcare professionals and clinicians, KLAS gathers data and insights on software and services to deliver timely reports and performance data that represent provider and payer voices and act as catalysts for improving vendor performance. The KLAS research team publishes reports covering the most pressing questions facing healthcare technology today, including emerging technology insights, that provide early insights on the future of healthcare technology solutions. KLAS also fosters measurement and collaboration between healthcare providers and payers and best practice adoption. Learn more at KLASresearch.com.

Fonte: Business Wire