Leveraging EDI for Interoperability and Application Intelligence

Though health plans have invested heavily to exchange documents with providers electronically, the opportunity to increase ROI through digital transaction remains largely untapped. This session will explore how EDI repositories and application flows can unleash its value to not only meet the most recent Interoperability rules, but to harness its ability to play an important role for business functions including membership, provider relations, care management, risk analytics, pre-adjudication and much more. Furthermore, CAQH 2019 Index reports we are saving 102 billion annually as an industry by exchanging transactions electronically. 

We will also discuss how by effectively utilizing those electronic transactions within business applications and machine learning, there is strong potential to make a bigger dent on our current 3.6 trillion GDP health care spend. 

Presenter: Ed Hafner is the AVP of Payer Strategy within the Medical Network for Change Healthcare. He provides strategic direction deriving health plan’s value from the electronic document exchange including pre-adjudication platform, machine learning, event-based processing, comparative analytics, and solution integrations. 

Before joining Change Healthcare, Ed was the General Manager of TIBCO’s Multi-Enterprise Connectivity Group that included B2B products, Health Care solutions, and Managed File Transfer products. Prior to TIBCO’s acquisition of Foresight, he served as Foresight’s Chief Technology Officer and was instrumental in the development of its HIPAA and ICD-10 solutions. 

Ed has been involved with EDI since 1983 including a 14-year tenure at Sterling Commerce where he served as Vice President of Development and Operations. Ed is active within WEDI as a six-term board member and currently co-chairs its Data Exchange work group. Other health care technology industry involvement includes Commissioner for EHNAC, co-chair of HCCO Certification, and CAQH’s CORE initiative. In addition to his involvement with health care, he has served other industry initiatives including retail, pharmaceutical, grocery, paper, and automotive.