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Average Ratings 0 Ratings

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ease
features
design
support

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Write a Review

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 No 

API Access

Has API No 

Screenshots View All

Screenshots View All

Integrations

XML No 

Integrations

XML Yes 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Pricing Details

No price information available.
Free Trial No 
Free Version No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Deployment

Web-Based Yes 
On-Premises No 
iPhone App No 
iPad App No 
Android App No 
Windows No 
Mac No 
Linux No 
Chromebook No 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Customer Support

Business Hours Yes 
Live Rep (24/7) No 
Online Support Yes 

Types of Training

Training Docs Yes 
Webinars No 
Live Training (Online) Yes 
In Person Yes 

Types of Training

Training Docs Yes 
Webinars Yes 
Live Training (Online) Yes 
In Person Yes 

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 Yes 
Appointment Management No 
Appointment Scheduling Yes 
Bed Management No 
Billing & Invoicing No 
Claims Management No 
In-Patient Management No 
Inventory Management No 
Medical Billing Yes 
Out-Patient Management No 
Patient Records Management No 
Physician Management No 
Policy Management No 
Revenue Management No 

Revenue Cycle Management

Accounts Receivable No 
Claims Management No 
Collections Management No 
EHR/EMR Integration No 
For Healthcare No 
ICD-10 Compliance No 
Insurance Verification No 
Medical Billing No 
Patient Portal No 
Patient Registration No 
Patient Scheduling No 
Payment Processing No 

Product Features

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