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Average Ratings 0 Ratings
Description
Whether you need assistance with grasping the intricacies of the CMS and ONC final regulations, crafting a strategy to meet compliance deadlines, or executing a practical solution, we are here to assist you. As a frontrunner in the field of interoperability, Edifecs possesses the necessary expertise to guide you in achieving adherence to the latest mandates while unlocking the potential of secure and dependable electronic health data exchange. Edifecs provides top-tier Smart Trading and Encounter Management solutions specifically designed for small to medium-sized health plans. By leveraging financial, clinical, and administrative data, organizations can advance their business strategies and facilitate automation in administrative tasks. Improve encounter management processes and enhance first-pass rates for managed Medicaid and Medicare Advantage through a hosted solution model that Edifecs offers. Additionally, Edifecs presents COTS-based modular solutions aimed at optimizing data quality and supporting payment reform initiatives. By utilizing these innovative tools, health plans can ensure a proactive approach to compliance and data management, ultimately leading to improved outcomes.
Description
To mitigate potential risks, the Centers for Medicare and Medicaid Services (CMS) have instituted guidelines to ensure the validation of their networks. Given that Pharmacy Benefit Managers (PBMs) are significantly impacted by the risk assessment process, the demand for precise and actionable insights has reached unprecedented levels. The LexisNexis Provider Integrity Scan streamlines a variety of provider verification processes and offers continuous monitoring by cross-referencing numerous files and lists, while also delivering automatic alerts for numerous high-risk factors. This tool is proficient in screening and verifying providers both before and after enrollment, aiming to uncover and thwart criminal activities effectively. By identifying potentially fraudulent providers and businesses involved in health-related programs, the LexisNexis Provider Integrity Scan serves to lower costs for health care payers and PBMs alike. Our innovative solution empowers users to effectively conduct multiple searches and access crucial information, enhancing their operational efficiency and security. This comprehensive approach not only safeguards the integrity of health care programs but also fosters a more reliable health care environment.
API Access
Has API
API Access
Has API
Integrations
XML
Pricing Details
No price information available.
Free Trial
Free Version
Pricing Details
No price information available.
Free Trial
Free Version
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Deployment
Web-Based
On-Premises
iPhone App
iPad App
Android App
Windows
Mac
Linux
Chromebook
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Customer Support
Business Hours
Live Rep (24/7)
Online Support
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Types of Training
Training Docs
Webinars
Live Training (Online)
In Person
Vendor Details
Company Name
Edifecs
Founded
1996
Country
United States
Website
www.edifecs.com
Vendor Details
Company Name
LexisNexis
Founded
1970
Country
United States
Website
risk.lexisnexis.com/products/provider-integrity-scan
Product Features
Hospital Management
Accounting Integration
Appointment Management
Appointment Scheduling
Bed Management
Billing & Invoicing
Claims Management
In-Patient Management
Inventory Management
Medical Billing
Out-Patient Management
Patient Records Management
Physician Management
Policy Management
Revenue Management
Revenue Cycle Management
Accounts Receivable
Claims Management
Collections Management
EHR/EMR Integration
For Healthcare
ICD-10 Compliance
Insurance Verification
Medical Billing
Patient Portal
Patient Registration
Patient Scheduling
Payment Processing