Up until now, risk adjustment has been addressed as a mechanism to accurately represent the overall risk profile of a health plan’s membership. A function that will still facilitate a health plan’s payment for taking on at-risk populations is about to go through its first major transformation – the use of risk adjustment data to drive value-based program initiatives. Now that the functional aspects
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Edifecs Acquires Risk Adjustment Solution Health Fidelity – M&A
What You Should Know: - Today, global health IT company, Edifecs announced it has entered a definitive agreement to acquire Health Fidelity, a San Francisco-based tech provider. Together, the companies will offer health plans and provider customers with the most complete risk adjustment solution in healthcare. Edifecs, Inc., a health information technology solutions company, announced today that it has signed a definitive agreement to acquire Health Fidelity, a
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Edifecs Acquires Talix to Expand Risk Adjustment Solution
What You Should Know: - Edifecs, a global health IT provider announced it is acquiring Talix, a SaaS IT company, to expand Edifecs’ reach in the encounter management and risk adjustment space. Financial details of the acquisition were not disclosed. - The integration of Edifecs’ and Talix’s technologies will create an expanded risk adjustment solution with critical workflows and insights that improve efficiencies and directly support payer and provider collaboration. Talix
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3 Strategies to Up-Level Medicare Advantage Enrollment Before it is Too Late
With a new administration looking to reshape healthcare policy and additional special enrollment periods already underway, now is the time to ensure Medicare enrollment systems are ready for the unpredictability, and potential opportunities, ahead. While Medicare is the fastest growing segment of the healthcare industry, it is also highly competitive, expensive to operate in, and riddled with complexities and regulations to navigate. Health plans don’t have room to make a misstep when it comes
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Analysis: August Health IT M&A Activity; Public Company Performance
– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of August 2020. M&A is back and the velocity of the rebound has outpaced all expectations. The recovery quickly worked its way across the spectrum from large to small-cap, beginning with the larger cap NASDAQ rally of nearly 80% from lows in late March (only to soften in recent days), followed by multi-billion
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Analysis: July Health IT M&A Activity; Public Company Performance
– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of July 2020. While a pandemic ravages the country, technology valuations are soaring. The Nasdaq hit an all-time high during the month of July, sailing through the 10,000 mark to post YTD gains of nearly 20%, representing a 56% increase off the low water mark on March 23. More notably, the Nasdaq has outperformed
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Why Government-Supported Health Plans Must Make Encounter Submissions A Top Priority in 2020
Encounter data such as diagnosed clinical conditions and services, or items delivered to healthcare consumers to treat these conditions is the key to success for all healthcare organizations participating within the government space. Whether doctors or hospitals are submitting data for medical services rendered under Medicare Advantage, the Affordable Care Act’s state exchanges or Medicaid, encounter data is used for payment reimbursement and reconciliation between the health plan and the
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The Blueprint to Scaling Social Determinants of Health (SDOH) Data Collection
In the value-based care world, cost-effective treatment, quality of care, and patient outcomes determine payment. Social determinants of health (SDOH) represent the economic, psychological, educational, environmental and social barriers that limit healthy behaviors, access to care and adherence to treatment resulting in poor health outcomes. Many stakeholders in health care are trying to address social determinants as part of their value-based care strategy. However, many organizations are
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Blue Cross Blue Shield Association Taps Edifecs to Drive FHIR Adoption
Blue Cross Blue Shield Association (BCBSA), today announced that it has chosen Edifecs as a partner to help drive FHIR adoption across BCBS companies. FHIR is the future of interoperability, and FHIR standards can resolve many of the healthcare industry’s critical business issues. As part of the partnership, Edifecs’ user-friendly Edifecs XEngine Server Module for FHIR will be offered to BCBS companies to support the rapid deployment of these data standards with minimal training required. What
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Edifecs Launches Hosted Encounter Management Model for MAOs and MCOs
Edifecs, a global health information technology solutions company, today announced the availability of its Encounter Management solution for small and mid-sized Managed Care Organizations (MCOs) and Medicare Advantage Organizations (MAOs). The Encounter Management software-as-a-service (SaaS) model helps health plans facilitate the encounter data submission process in the transition from Risk Adjustment Payment System (RAPS) to the Encounter Data Process System (EDPS) with no infrastructure
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