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What is LexisNexis Provider Integrity Scan?

In order to address potential risks, the Centers for Medicare and Medicaid Services (CMS) have established guidelines aimed at validating their networks. The significant influence of risk assessment processes on Pharmacy Benefit Managers (PBMs) has led to an unprecedented demand for accurate and actionable insights. The LexisNexis Provider Integrity Scan simplifies a variety of provider verification tasks and maintains continuous oversight by cross-referencing a multitude of files and lists, while additionally providing automatic notifications for various high-risk indicators. This tool excels in screening and validating providers both prior to and after enrollment, effectively working to detect and prevent criminal activities in the sector. By identifying potentially fraudulent providers and entities associated with health programs, the LexisNexis Provider Integrity Scan contributes to cost reduction for health care payers and PBMs. Furthermore, our cutting-edge solution enables users to perform multiple searches and access vital information, thereby improving their operational efficiency and security. This comprehensive strategy not only protects the integrity of health care programs but also cultivates a more trustworthy healthcare landscape, ultimately benefiting patients and providers alike.

What is Edifecs?

If you require help navigating the complexities of the CMS and ONC final regulations, developing a compliance strategy, or implementing an effective solution, we are ready to support you. As a leader in interoperability, Edifecs has the expertise to assist you in meeting the newest requirements while enabling the secure and efficient exchange of electronic health data. Our exceptional Smart Trading and Encounter Management solutions are tailored for small to medium-sized health plans. By harnessing financial, clinical, and administrative data, organizations can enhance their operational strategies and streamline administrative processes. Enhance your encounter management systems and boost first-pass rates for managed Medicaid and Medicare Advantage with the hosted solution model offered by Edifecs. Furthermore, Edifecs provides COTS-based modular solutions that focus on improving data quality and facilitating payment reform efforts. With these cutting-edge tools, health plans can adopt a proactive stance towards compliance and data management, ultimately driving better health outcomes for their members. Our commitment to innovation ensures that you are not only meeting compliance but also thriving in an evolving healthcare landscape.

Media

Media

Integrations Supported

XML

Integrations Supported

API Availability

API Availability

Pricing Information

Pricing not provided

Pricing Information

Pricing not provided

Supported Platforms

SaaS

Supported Platforms

SaaS

Customer Service / Support

Standard Support
Web-Based Support

Customer Service / Support

Standard Support
Web-Based Support

Training Options

Documentation Hub
Webinars
Online Training
On-Site Training

Training Options

Documentation Hub
Online Training
On-Site Training

Company Facts

Organization Name

LexisNexis

Date Founded

1970

Company Location

United States

Company Website

risk.lexisnexis.com/products/provider-integrity-scan

Company Facts

Organization Name

Edifecs

Date Founded

1996

Company Location

United States

Company Website

www.edifecs.com

Categories and Features

Healthcare Compliance

Not specified

Categories and Features

Healthcare Compliance

Not specified

Hospital Management

Accounting Integration
Appointment Scheduling
Medical Billing

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