Easing the IT burden for small and mid-sized managed care plans, solution ensures encounter data compliance with CMS and State Medicaid requirements, improves revenue integrity
BELLEVUE, Wash.–(BUSINESS WIRE)–Edifecs, Inc., a global health information technology solutions company, announced that it has been selected by Doctors HealthCare Plans, Inc. to implement its hosted Encounter Management for SMB (small and mid-tier) solution designed specifically for managed care plans operating in Medicare Advantage and/or within managed Medicaid lines of business.
With this entirely hosted, scalable and cost-effective solution, Edifecs will remove the IT burden and administrative pressure that often comes with ensuring encounter data submission compliance, while constantly managing changing state requirements. Reducing strain on the Doctors HealthCare Plans encounter operations team, Edifecs’ experts will take over the encounter management process and ensure the best outcomes.
For managed care plans with fewer than 100,000 members, enterprise-grade technology solutions do not meet the unique needs of their leaner business models. Many smaller and mid-tiered plans struggle with data compliance and revenue accuracy while navigating cumbersome IT infrastructure and staffing limitations. Edifecs’ technology completely removes the burden of implementation and ongoing compliance while improving first-pass rates and revenue integrity.
Doctors HealthCare Plans, which provides coverage to 15,000 Medicare-eligible individuals throughout Miami-Dade County, will significantly increase the size of its encounter operations bandwidth with the addition of Edifecs’ encounter experts who will help the plan avoid financial penalties, achieve 99% first-pass encounter acceptance rates, prioritize the most revenue-impactful corrections and resubmissions and track it all through interactive dashboards.
“We are proud to work with Doctors HealthCare Plans and help the organization implement an affordable and scalable solution that fits its infrastructure perfectly. We believe all healthcare payers and providers should enjoy the benefits of ‘enterprise-grade’ technology no matter their budget,” said Sunny Singh, president and CEO, Edifecs. “With our best-in-class encounter management solution, health plans of any size can achieve cost savings and operational efficiencies in their encounter operations.”
One half of the Edifecs’ SMB Solutions suite, Encounter Management for SMB, is delivered as a software as a service and supports all government programs including Medicare Advantage, managed Medicaid, dual eligible and the HealthCare.gov marketplace.
Doctors HealthCare Plans joins a growing list of new Edifecs clients this year. Most recently, the Commonwealth of Pennsylvania chose Edifecs to provide electronic data interchange module services for its state Medicaid agencies.
For more information about Edifecs and its work with small and medium sized health plans, visit: https://www.edifecs.com/special-markets/edifecs-for-smb/edifecs-for-smb-overview/.
Edifecs develops innovative, cost-cutting information technology solutions to transform the global healthcare marketplace. Since 1996, Edifecs technology has helped healthcare providers, insurers, pharmacy benefit management companies and other trading partners trim waste, reduce costs and increase revenues. More than 350 healthcare customers today use Edifecs solutions to simplify and unify financial and clinical transactions. In addition, Edifecs develops supply chain management solutions to support worldwide customers in non-healthcare industry segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at www.edifecs.com.