Average Ratings 0 Ratings
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
No
API Access
Has API
No
Integrations
XML
No
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