Edifecs Strengths, Domain Expertise, and Key Differentiators
Edifecs is a leading healthcare technology firm committed to enhancing healthcare outcomes, lowering costs, and fostering innovation by optimizing the entire process of patient data exchange, thereby enhancing overall healthcare efficiency. This mission underscores the company's dedication to driving positive impacts within the healthcare industry through streamlined processes and improved interoperability.
Edifecs Recent Developments
In September 2022, Edifecs introduced a new solution designed to fully automate prior authorization processes at the point of care, resulting in enhanced member experiences, improved outcomes, sustained compliance, and decreased administrative burdens. This innovative solution seamlessly integrates with electronic health records (EHR) and harnesses the power of artificial intelligence (AI), natural language processing (NLP), and industry standards such as Fast Healthcare Interoperability Resources (FHIR) to instantly facilitate authorization. Key features of Edifecs' automated prior authorization solution include comprehensive payer prior authorization management workflows, complete with tracking, monitoring, and reporting functionalities. Moreover, the solution seamlessly integrates with existing utilization management systems and interfaces with the payer's clinical guideline repository for streamlined operations. By leveraging industry standards like FHIR and drawing from over 40 payer implementations for patient access, Edifecs' prior authorization solution significantly reduces the time to care by enabling EHR-agnostic integration with healthcare providers.
With the acquisitions of Talix and Health Fidelity in 2021, Edifecs seamlessly integrated the two companies' advanced technologies into its flagship Encounter Management solution. This integration empowers customers to optimize risk adjustment processes for Medicare Advantage, Managed Medicaid, and Affordable Care Act (ACA) products with greater efficiency. By incorporating Health Fidelity's and Talix's Natural Language Processing (NLP) and Artificial Intelligence (AI) capabilities into Edifecs's workflow solutions, the company is poised to offer one of the most comprehensive Risk Adjustment solutions available in the market.
Edifecs Mergers and Acquisitions (M&A) Activities
In December 2021, Edifecs concluded the acquisition of Health Fidelity, a prominent provider of risk adjustment solutions. This strategic integration positions Edifecs to deliver industry-leading Natural Language Processing (NLP), workflow, and submissions solutions, significantly augmenting suspecting and financial analytics capabilities for its customers. The enriched portfolio ensures a seamless solution, eliminating the need for customers to incur expenses related to intricate integrations and multi-vendor management overhead.
In September 2021, Edifecs acquired Talix, an esteemed information technology company specializing in risk and quality solutions for healthcare payers and providers. The strategic integration of Edifecs' and Talix's technologies resulted in an enhanced risk adjustment solution. The synergistic blend of workflows and insights that derive from both entities significantly enhances operational efficiencies and fosters direct collaboration between payers and providers.
Edifecs Customers in ARTW Customer Database
Leveraging a rigorous data-centric research methodology, APPS RUN THE WORLD asks the simple question: Who’s buying Edifecs applications and why? And we provide the answers – supported by decades of research – to our clients around the world. Our Customer database has over 100 data fields that detail company usage of Edifecs and other enterprise apps by function, customer size, industry, location, implementation status, partner involvement, Line of Business Key Stakeholders and IT decision makers contact details. List of Verified Edifecs customers.
Edifecs Overview
1756 114th Avenue SE
Bellevue, WA, 98004, United States
1 425-435-2000
https://www.edifecs.com/
Ownership: - x
Number of Employees: 1000
Functional Markets: ERP Services and Operations,
Key Verticals: Banking and Financial Services, Federal Government, State and Local Government, Public Safety, Healthcare, Manufacturing, Professional Services, Retail, Transportation,
Edifecs Key Enterprise and Cloud Applications
Edifecs
Edifecs Revenues, $M:
| Type/Year | 2022 | 2023 | YoY Growth, % |
|---|---|---|---|
| Total Revenues, $M | Subscribe | Subscribe | Subscribe |
| Enterprise Applications Revenues, $M | Subscribe | Subscribe | Subscribe |
| Cloud Applications Revenues, $M | Subscribe | Subscribe | Subscribe |
* Enterprise Applications Revenues = License + Support & Maintenance + SaaS
** All revenue figures are estimates based on public records, Cloud and Non-Cloud business models in Apps Run The World's vendor database, and annual survey results including vendor feedback.
Edifecs Revenue Breakdown By Type, $M:
Edifecs Enterprise Applications Revenues By Functional Markets, $M:
Edifecs Enterprise Applications Revenues By Verticals, $M:
Edifecs Revenues By Region, $M
| Region | % of Total Revenues | 2023 Total Revenues, $M | 2023 Enterprise Applications Revenues, $M | 2023 Cloud Applications Revenues, $M |
|---|---|---|---|---|
| Americas | Subscribe | Subscribe | Subscribe | Subscribe |
| EMEA | Subscribe | Subscribe | Subscribe | Subscribe |
| APAC | Subscribe | Subscribe | Subscribe | Subscribe |
| Total | Subscribe | Subscribe | Subscribe | Subscribe |
Edifecs Direct vs Indirect sales
| Region | Direct Sales | Indirect Sales | Total |
|---|---|---|---|
| Type % | Subscribe | Subscribe | Subscribe |
| Revenues, $M | Subscribe | Subscribe | Subscribe |
Edifecs Customers - Breakdown by Geo, Size, Vertical and Product
List of Verified Edifecs Customers
No. of Edifecs Customers: 400
No. of Edifecs Enterprise Applications Customers: 400
No. of Edifecs Cloud Customers: x
No. of Edifecs Cloud Subscribers: x
They boast a customer base of over 400 entities, with 350 in the healthcare sector and an additional 50 non-healthcare customers spanning international markets. Moreover, they serve 70 provider organizations across 23 states within the United States. Edifecs’ growing customer base is predominantly comprised of health payers and providers, as well as state and federal agencies, transportation and logistics, retail, financial services, manufacturing, and more.
The company has gained extensive market penetration among Blue Plans, serving 25 out of the 37 BCBS Licenses. Additionally, they have significant clientele in State Medicaid programs and CMS.
Among Edifec's customers are the majority of Blue Cross Blue Shield Plans, Centene Corporation, ClearConnect, Centers for Medicare and Medicaid Services, Humana, MultiPlan, and many others.
Edifecs Market Opportunities, M&A and Geo Expansions
Following significant leadership changes in 2022, the company underwent another organizational transformation in 2023. That involved the addition of Chris Lance as Chief Product Officer, Stephen Ayers as Chief Financial Officer, and Tom Shultz as Chief Revenue Officer. This alternation in the organization is oriented toward a focus on driving growth, leading product strategy, and delivering a portfolio of innovative and high-performing products and solutions.
In August 2022, Edifecs bolstered its leadership team with the addition of four new executives, responding to the company's robust growth in 2021. The new appointments encompass Raymond Bonnett as Vice President of Professional Services, Mark Filiault as Vice President of Payer Sales, Paul “Chip” Acton as Vice President of Solution Consulting, and Brian Hanley as Vice President of Public Sector Sales. With extensive industry experience and leadership acumen, these executives are poised to spearhead growth strategies, enabling the company to further enhance customer-centric solutions for advancing data exchange within the healthcare sector.
Edifecs Risks and Challenges
The company's geographical and sectoral limitations pose significant risks to its organizational development and expansion into international markets.
Edifecs Ecosystem, Partners, Resellers and SI
In February 2023, Edifecs and VirtualHealth, a leading medical management technology company, unveiled a collaboration aimed at offering automated prior authorization services through VirtualHealth's HELIOS platform to healthcare payer and provider clients. By integrating Edifecs' solution, the prior authorization process within HELIOS is streamlined and optimized, resulting in significant reductions in administrative burdens and friction between payers and providers, thereby expediting patient care. VirtualHealth responded to client feedback by adding Edifecs' prior authorization solution to enhance the efficiency of prior authorization processes for commercial health plans, ACOs, home health agencies, and healthcare systems.
In January 2023, Edifecs and 3M Health Information Systems (HIS) (leader in coding, patient classification and grouping, performance management software, and consulting services) announced a collaborative effort to integrate their cutting-edge technologies. This collaboration presents a unique solution tailored for both payers and providers, facilitating the accelerated adoption of Value-Based Payment (VBP) models. By combining Edifecs' VBP actuarially-driven templates and precision risk intelligence capabilities with 3M's patient classification methodologies, the joint solution addresses barriers hindering the rapid uptake of alternative payment models. This innovative approach empowers payers and risk-bearing providers to effectively quantify the value of preventing adverse events and allocate accountability across various providers, health systems, and payment arrangements.
In November 2022, Edifecs and Empowered-Home announced a strategic partnership aimed at offering automated prior authorization services to various healthcare entities including medical associations, Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), medical groups, and home healthcare agencies. Empowered-Home added Edifecs' prior authorization solution into its unique partner ecosystem, centered around virtual care management, to support ACOs, IPAs, and health plans in achieving clinical and financial success amidst the shift towards remote value-based care. The collaboration leverages the combination of Edifecs' prior authorization solution and the clinical decision support system provided by Privis Health, thus forming the cornerstone of Empowered-Home's comprehensive ecosystem.
The company is based in Bellevue, Washington, with supplementary offices strategically located in Atlanta, Georgia, San Francisco, California, and Pittsburg, Pennsylvania. Additionally, it operates engineering centers in Mohali, India, as well as in Moldova, Belarus, and Ukraine.
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Research Methodology
Data used in research reports are derived from publicly available documents, continuous surveys of applications vendors, customers, resellers, Independent Software Vendors, systems integrators and other verifiable sources.
Vendor shares and market forecast results are based on a combination of existing databases as well as demand side and supply side research conducted throughout the year with validation from vendors, customers, channel partners and documentations such as earnings releases and 10Q and 10K filings, vertical industry studies, regional and country-level statistics from public and private institutions(i.e. colleges, universities, government agencies and trade associations).
For additional information on our methodologies, here's the link:
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