Edifecs Selected As Bluegrass Family Health's Operating Rules Partner

Kentucky-based Health Plan Provider Will Benefit from Streamlined Processes, Increased Member Satisfaction

Recently, Edifecs, Inc., a leading provider of healthcare software solutions specializing in regulatory compliance solutions for healthcare providers and health plans, announced that Bluegrass Family Health (Bluegrass), a Kentucky-based, not-for-profit company offering group health insurance to businesses in Kentucky and Southern Indiana, has selected Edifecs as its strategic partner for Operating Rules compliance. Implementing Operating Rules is a step toward Administrative Simplification and will enable real-time identification of patient benefits and financial responsibility as mandated in the Patient Protection and Affordable Care Act of 2010.

The Edifecs Operating Rules Solution will help Bluegrass achieve rapid cost savings, enhanced productivity and increased member and provider satisfaction by complying with Operating Rules. As the health insurance arm of the Baptist Health System, Bluegrass sought a strategic compliance partner that would allow it to consolidate its infrastructure for processing transactions. In addition, Edifecs’ Operating Rules Solution gives Bluegrass the ability to better log, track and audit claims transactions.

“As a regional organization, we were looking for a partner to help us with a solution that would ease transaction management and increase satisfaction among our members,” said Preston Gorman, director of IT for Bluegrass Family Health. “We selected Edifecs because of its industry credibility and flexibility to work with health plans of any size – they worked with us to implement a solution and structured roll-out that is appropriate for the size of our company. The intuitive platform will ease training across multiple departments, allowing for an expanded user base within our organization, freeing up more time on our IT team to focus on meeting other requirements.” 

Health plans have limited time to test and implement technology for Operating Rules compliance, and many are overwhelmed by additional healthcare mandates on the agenda such as ICD-10 and Health Insurance Exchanges. For smaller payers, including Bluegrass, it is also difficult to hire and train enough IT staff for a project that will require dedicated resources over future updates as well as consistent monitoring and maintenance of IT systems.

The Edifecs solution allows health plans to save time while achieving cost-efficient and scalable compliance with Operating Rules, with future-proofing for new mandates down the road. With an easy-to-use interface and modern front-end infrastructure, health plans look to Edifecs to improve business processes and gain faster access to detailed information about member benefits, deductibles and expected costs, which providers can share at the point of care.

“Bluegrass Family Health is a wonderful example of how payers of any size can simplify their administrative processes and maintain compliance with the latest mandates,” said Sunny Singh, CEO of Edifecs. “We are proud to support Bluegrass Family Health as its partner for Operating Rules compliance. With a focus on member and provider satisfaction, our goal is to equip our health plan customers with a streamlined and cost-effective solution that will enable them to demonstrate compliance and achieve their business objectives without draining their already limited resources.” 

About Bluegrass Family Health
Bluegrass Family Health is a Kentucky-based, not-for-profit company offering group health insurance to businesses in Kentucky and Southern Indiana. Headquartered in Lexington, KY, Bluegrass Family Health provides employer group insurance with a wide array of products to meet the needs of the marketplace. Bluegrass Family Health offers products for both fully insured and self-funded employers. At the forefront of the Consumer Choice Healthcare movement for the region, Bluegrass Family Health also offers HRA and HSA compatible plans, in addition to traditional HMO and PPO plan designs.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA 5010 and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, visit www.edifecs.com.