List of Edifecs Operations Cloud Customers
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United States
Since 2010, our global team of researchers has been studying Edifecs Operations Cloud customers around the world, aggregating massive amounts of data points that form the basis of our forecast assumptions and perhaps the rise and fall of certain vendors and their products on a quarterly basis.
Each quarter our research team identifies companies that have purchased Edifecs Operations Cloud for Healthcare ERP from public (Press Releases, Customer References, Testimonials, Case Studies and Success Stories) and proprietary sources, including the customer size, industry, location, implementation status, partner involvement, LOB Key Stakeholders and related IT decision-makers contact details.
Companies using Edifecs Operations Cloud for Healthcare ERP include: Centene, a United States based Healthcare organisation with 60500 employees and revenues of $163.07 billion, HCSC (Health Care Service Corporation), a United States based Banking and Financial Services organisation with 28000 employees and revenues of $54.75 billion, AmeriHealth Caritas, a United States based Insurance organisation with 10000 employees and revenues of $23.70 billion and many others.
Contact us if you need a completed and verified list of companies using Edifecs Operations Cloud, including the breakdown by industry (21 Verticals), Geography (Region, Country, State, City), Company Size (Revenue, Employees, Asset) and related IT Decision Makers, Key Stakeholders, business and technology executives responsible for the software purchases.
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| Logo | Customer | Industry | Empl. | Revenue | Country | Vendor | Application | Category | When | SI | Insight |
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AmeriHealth Caritas | Insurance | 10000 | $23.7B | United States | Edifecs | Edifecs Operations Cloud | Healthcare ERP | 2024 | n/a |
In 2024 AmeriHealth Caritas implemented Edifecs Operations Cloud within the Healthcare ERP category, deploying Edifecs Clinical Insights to embed a claims and analytics workflow that sends provider facing 277CA alerts for its Medicaid and Medicare plan. The public provider FAQ and program guide document that the Plan worked directly with Edifecs to enable the Clinical Insights workflow and to communicate provider participation and response expectations.
The implementation centers on the Edifecs Clinical Insights claims and analytics workflow, configured to generate provider facing alerts using the 277CA transaction to surface potential missing diagnoses and coding opportunities. Functionally the deployment supports diagnosis capture, documentation prompts to providers, and downstream claims accuracy and risk adjustment data capture, leveraging analytics to identify encounters requiring follow up.
Operational coverage described in the program materials spans the Plan s provider network and claims operations, with repository and notification controls managed inside Edifecs Operations Cloud. The public program guide and provider FAQ serve as governance artifacts, outlining provider outreach, alert handling workflows, and the operational roles of provider relations, claims operations, and risk adjustment teams.
Documentation explicitly states outcomes tied to the deployment, noting improved diagnosis capture and timelier claim processing that support risk adjustment and claims accuracy for the Medicaid and Medicare lines of business.
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Centene | Healthcare | 60500 | $163.1B | United States | Edifecs | Edifecs Operations Cloud | Healthcare ERP | 2024 | n/a |
In 2024, Centene implemented Edifecs Operations Cloud. Edifecs Operations Cloud was deployed as a Healthcare ERP to operationalize risk adjustment and encounter submission workflows, reflecting Centene executives’ engagement on an Edifecs-led RISE National panel about integrating prospective and retrospective risk adjustment with encounter submissions.
The deployment focused on modules aligned to risk adjustment and encounter submissions, including prospective and retrospective risk adjustment workflows, encounter submission processing, data validation and reconciliation, and compliance orchestration. Edifecs Operations Cloud was configured to sequence encounter intake, automated eligibility of records for risk adjustment review, and staged compliance checks that support operational processing of encounter data.
Governance and operational structuring concentrated on risk adjustment and encounter operations teams, establishing workflow orchestration for submission pipelines and defined compliance checkpoints. The implementation narrative emphasizes operational integration between encounter submission processing and risk adjustment functions, with process controls and role-based workflow handoffs designed to align clinical encounter data handling with regulatory and compliance requirements.
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HCSC (Health Care Service Corporation) | Banking and Financial Services | 28000 | $54.7B | United States | Edifecs | Edifecs Operations Cloud | Healthcare ERP | 2023 | n/a |
In 2023 HCSC implemented Edifecs Operations Cloud and began production engagement on interoperability and prior authorization workflows in late 2023. The deployment is cataloged under the Healthcare ERP category and centers on payer-facing transaction orchestration for authorization and consent scenarios. Edifecs Operations Cloud is referenced by HCSC and Edifecs in public materials and was demonstrated in joint presentations at HIMSS24 in March 2024.
The implementation uses specific modules for prior authorization intake and adjudication, FHIR gateway functionality, EDI gateway processing, and consent management. Configuration work focused on claim and authorization transaction routing, FHIR resource mapping and validation, and EDI 837/278 style transaction orchestration consistent with payer authorization workflows. These module-level capabilities support automated intake, eligibility verification, and authorization status tracking within payer operational processes.
Integrations emphasize FHIR API endpoints and EDI transaction interfaces to connect payer systems and provider networks, reflecting interoperability use cases described in vendor and joint presentation materials. The deployment is cloud hosted under the Edifecs Operations Cloud offering and is scoped to payer operational teams responsible for prior authorization and interoperability, including clinical operations and prior authorization processing groups.
Governance and compliance workstreams were part of rollout planning, with HCSC and Edifecs co presenting on CMS 0057 F compliance at HIMSS24, signaling alignment of the implementation to regulatory messaging and standards. Operational changes included embedding consent management into authorization workflows and instituting policy based routing and audit logging for FHIR and EDI exchanges.
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