Achieving Business Scalability with 99% Acceptance Rates

NAMM California works as a delegated model, contracting with health plans to manage risk associated with delivering healthcare services. It is responsible for managing member care as well as running back office operations such as adjudicating claims and sending encounter data directly to the insurer. To gain additional processing efficiencies and manage the increasing number of submissions, NAMM California sought an encounter management solution partner with end-to-end tracking and analysis capabilities that could assist in onboarding new health plan organizations.

Using the Edifecs Encounter Management solution, NAMM California has been able to share cleaner encounter data with their trading partners, resulting in significantly fewer rejections. The team has increased first pass acceptance rates, submitted millions of transactions, and increased its overall acceptance rate to over 99.9%.

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Edifecs Inc. is a global healthcare software company committed to improving outcomes, reducing costs, and elevating the value of healthcare for everyone. Edifecs delivers the industry’s premier IT partnership platform to providers, insurers, pharmacy benefit management companies, and other trading partners. By mobilizing its leading solutions at the front end of the healthcare information pipeline, Edifecs provides a unified platform for partners to flexibly pilot and scale new initiatives using their existing enterprise systems. Since 1996, hundreds of healthcare customers have relied on Edifecs partnership solutions to future-proof their leading initiatives in the midst of a dynamic healthcare landscape. Edifecs is based in Bellevue, WA, with operations internationally. Learn more about us at edifecs.com.

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