Washington State Health Benefit Exchange Achieves Success with Edifecs for EDI Transaction Processing

Business Wire

Partnership improves quality, timeliness and reconciliation of the marketplaces’ EDI transactions

BELLEVUE, Wash.--(BUSINESS WIRE)-- Edifecs, a global health information technology solutions company, announced a strategic partnership with the Washington Health Benefit Exchange (WAHBE). The state-run marketplace implemented the Edifecs Health Insurance Exchange (HIX) Integration Solution to improve the exchange of electronic data between the Washington Healthplanfinder and participating Qualified Health Plans (QHP). The streamlined electronic data interchange (EDI) simplified the process for plans to participate in the exchange and ensured that consumers in Washington State were offered many plans to choose from.

For QHPs, Edifecs’ technology enabled standard interfaces and accelerated participation in the state-based exchange marketplace with condensed go-to-market times and lowered cost. WAHBE now has the ability to proactively and quickly resolve issues between the exchange and consumer transactions in real time, eliminating future challenges that could impact exchange operation and access during enrollment season.

The Edifecs HIX Integration Solution transitioned EDI management from custom-developed applications. In addition to ensuring compliance with Center for Medicare and Medicaid Services (CMS) reporting requirements and WAHBE standards, the integration of Edifecs’ technology improved the quality and error processing of enrollment transactions and eliminated payment data errors.

“We are thrilled at what we have accomplished working with the Edifecs’ team of engineers and experts,” said Chris Johnson, Associate IT Director at WAHBE. “The WAHBE is committed to giving the people of Washington a streamlined enrollment experience and Edifecs’ technology has enabled our team to operate more efficiently, and to transmit and receive consumer enrollment data both accurately and quickly.”

The program was fully deployed for the 2016 open enrollment period. The project was funded through a CMS grant.

“Washington is one of the more progressive states in response to health reform. This partnership helped ensure that WAHBE maintains is leadership among the state-run exchange and continues to improve on the experience,” said Sunny Singh, CEO of Edifecs. “In retail-based healthcare, it is critical that exchange disruptions are minimal and enrollment is standardized, our work with WAHBE has enabled seamless transactions and automated processing.”

WAHBE was the first of two Edifecs state-based marketplace customers. Edifecs also provides enrollment technology solutions to many commercial plans and CMS. The Edifecs HIX Integration Solution enables state exchanges to consolidate critical functionality into a specialized EDI transaction processing platform. The goal is twofold: First to improve the quality, timeliness, and reconciliation of EDI transactions; and second to provide new standards and formats for improving issuer-automated processing at a lower total cost.

About Edifecs

Edifecs develops innovative, cost-cutting information technology solutions to transform the global healthcare marketplace. Since 1996, Edifecs technology has helped healthcare providers, insurers, pharmacy benefit management companies and other trading partners trim waste, reduce costs and increase revenues. More than 350 healthcare customers today use Edifecs solutions to simplify and unify financial and clinical transactions. In addition, Edifecs develops supply chain management solutions to support worldwide customers in non-healthcare industry segments. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at www.edifecs.com.