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The San Francisco Health Plan Story: The Drive to Continuous Encounter Compliance and Provider Reimbursement Accuracy

San Francisco Health Plan (SFHP) strives to provide high-quality medical care to the largest number of low-income San Francisco residents possible, while supporting the area’s public and community-minded providers. As part of their pursuit of quality and excellence in all operational areas, SFHP recognized a need to improve the accuracy and compliance of their encounter data submissions to the state and to ensure their capitated providers were fully reimbursed. However, they were challenged by the high ongoing cost of a home-grown encounter solution, compliance regulations enforced by the California Department of Health Care Services (DHCS) and a lack of encounter transparency and reconciliation.

In this case study, learn why SFHP selected Edifecs Encounter Management to improve their processing efficiency and risk adjustment scoring accuracy, all while reducing IT TCO.

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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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