Modernize Healthcare EDI with AI Agents

Save Operations Cost using AI agents. Migrate from Legacy Edifecs. All EDI transactions integrated with FHIR.

What is EDIVal?

EDIVal is a comprehensive Healthcare EDI platform designed for healthcare insurance companies. It offers robust support for payer EDI transactions across various healthcare plans, including Medicare, Medicaid, MediCal, State Plans, Marketplace, and large group commercial plans.

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Enable Gen AI for your Healthcare EDI

Enable GenAI and AI models for your existing EDI. Modernize your EDI to use the power of AI. Gen AI can help you answer operational questions, triage issues and data errors, colloboarate with your IT. Use Predictive AI models to identify data errors, EDI edit and catch errors and fraud before transactions reach your core applications.

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What you get!

Input Data Connectors

Connect and Convert Any Data. 50+ Connectors from API, SFTP, MLLP, XML, SOAP, EHRs, Epic, Salesforce and more.

EDI Data Mapping

No Code FHIR Data Converter with AI.

Pre-built data mappings for conversions.

EDI Data Repository

Store, manage, and facilitate access to healthcare data in compliance with the FHIR standard.

EDI API Server

Enables seamless healthcare data exchange and interoperability.

EDI Data Validation

Automated data validation, mapping, and transformation processes.

EDI Data Security

Uses latest Oauth 2.0 authentication and follows the HIPAA compliance.

One Solution, Infinite Possibilities!

Claims Management

Everything you need to manage claims

837 I, P, D Inbound and outbound
277CA, 999, TA
Claims Validations L1-L7
Claims Edits
Claims ICD Codes
Claims Status
Claims Payments Reconcile
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

Prior Authorization

Everything you need to manage prior authorization

278 Prior Auth real time and batch
Manage prior auth queue
Approve and Deny Prior auth
Manage Attachments
Manage Case notes
AI driven confidence code
Check eligibility
Integrated with Pega, QNXT, Facets, HealthRules
Integrated with CMS FHIR

CORE Claims Status

Everything you need to manage real-time and batch claims status

276/277 CORE transaction
Integrated with CMS
Core Rules
Claims Status API
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

Claims Payments

Everything you need to generate claims payments

835
Reconcile with 837 claims data
Compare line items payments
Match Lockbox files
Match with Invoices
Integrate with GL
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

Membership Management

Everything you need to manage memberships, enrollments, benefits, eligibility

834 Inbound and outbound
Custom 834
Flat file to 834
Enrollment reconcile
Member check, PCP check
Medicare, Medicaid
Dual Plan Rate Codes
Audit file reconcile
Full File reconcile
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

CORE Eligibility

Everything you need to manage real-time and batch eligibility

270/271 CORE transaction
Integrated with CMS
Core Rules
Eligibility API
Utilization
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

Attachments

Everything you need to manage attachments

275
Case Notes and attachments
Attach to Claims or Prior Auth
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

820 Payments

Everything you need to manage 820 FFS Payments

Generate or Load 820
Reconcile with membership
Manage Invoice Payments
Integrate to GL
Integrated with QNXT, Facets, HealthRules
Integrated with CMS FHIR

Implement Enterprise Healthcare EDI Platform - EDIVal

EDIVal has built in support for Payers EDI transactions for Medicare, Medicaid, MediCal, State Plans, MarketPlace and Large group commercial plans. Replace or Upgrade your existing expensive or custom EDI platform to EdiVal.

We support all EDI Transactions - Claims, Enrollments, Prior Authorization, Eligibility, Payments, Attachments, Claims status.

See How

Enable AI driven EDI corrections, work queues and no code rules

Modernize your EDI to next generation AI auto data validation and data corrections. Manage various work queues with GenAI integration. Support multiple line of business or multiple states using our business rules templates and no code configuration.

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