Blue Cross and Blue Shield of Vermont Selects Edifecs to Integrate its IT Systems with Vermont’s Health Insurance Exchange (HIX)

Off-the-Shelf Integration Solution will Help Insurer  Maximize Opportunity, Minimize  Disruption and Deliver a Smooth Experience to Individuals and Small Business Participating on the Exchange

BELLEVUE, Wash.—May 22, 2013— Today, Edifecs, Inc., a leading healthcare solutions provider specializing in healthcare information management and compliance technology, announced that Blue Cross and Blue Shield of Vermont (BCBS of VT) has chosen the company as its technology integration partner in anticipation for preparing to  integrate with Vermont Health Connect, the state’s health insurance exchange (HIX). Beginning in October of this year, more than 100,000 Vermont residents, individuals and small groups with 50 or fewer employees, will be required to transition to Vermont Health Connect for their health care coverage as part of what may be the largest open enrollment period in history nationwide. Health insurance exchanges are mandated as part of the Affordable Care Act.

BCBS of VT is deploying the Edifecs HIX Integration Solution, a hosted solution that integrates member enrollment and billing transactions among insurers, state health insurance exchanges and the federal government to reduce the implementation and operational risk of participating on an HIX. Of key concern for health plans during the first year or two of operating on an HIX are the expected changes and disruptions that will occur as state exchanges, the federal government and the healthcare industry work toward stable and predictable processes and system integration.

The Edifecs HIX Integration Solution serves as a “guardian” for a health plan’s HIX business—shielding and monitoring interactions with HIXs, financial institutions and the federal government. It ensures that only accurate and timely information is sent to core membership systems or reported to the federal government.

“As is the case with most of the health plan industry, we continue to be concerned about the operational readiness of the State and the Federal Governments HIX technical integration with us and we are doing everything we can to not let that impact the consumer experience and to ensure our members and all eligible Vermonters are able to enroll on day one,” said Dan Galdenzi, CIO of BCBS of VT.

“To feel more comfortable implementing a project as large as the State’s exchange in such an abbreviated time period we chose Edifecs for its ability to help reduce the impact on our existing IT infrastructure and streamline our integration timeline. Edifecs is a proven partner of ours and their experience with enrollment and claims management made this solution the right technology fit for BCBS of VT.”

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. According to a recent survey of healthcare professionals at the 2013 Healthcare Mandate Summit, HIX participation in 2014 will be high. The survey also revealed the country’s health insurers are confident they will be ready by the October 1, 2013 launch deadline, but have reservations about how HIXs will be implemented and run.

“While most of the country is focused on the scheduled open enrollment date, the real challenge comes with the operational changes to the business and the long term sustainability of participation in the exchanges,” said Sunny Singh, CEO of Edifecs. “Edifecs is committed to supporting Blue Cross and Blue Shield of Vermont through the process of readying its IT systems for the state exchange, maintaining an outstanding member experience, and ensuring the long term success of its participation.”

BCBS of VT has taken a leading role in helping Vermont residents understand their health insurance options on the new HIX. It recently launched a new phone line staffed by trained representatives who can answer questions and provide detailed information about Vermont Connect. BCBS of VT has also held more than 35 community meetings all across the state with more than 1,600 small businesses and has many more planned in the weeks and months ahead.

In addition to the new phone line and trained staff, the company will also host webinars, enrollment meetings and provide one-on-one support at a new retail location in South Burlington, which opens in early May to help Vermonters find the coverage that is right for them.

On January 1, 2014, enrolled members will start using their health benefits, which means all qualified health plans, benefit tiers and payment contracts must be loaded and integrated with insurer IT systems to ensure members receive appropriate benefits and providers are paid promptly.

About BCBS of VT

Blue Cross and Blue Shield of Vermont is the state’s oldest and largest health insurer, providing coverage for about 180,000 Vermonters. It employs about 340 Vermonters at its headquarters in Berlin and branch office in South Burlington, and offers group and individual health plans. More information about Blue Cross and Blue Shield of Vermont is available on the Internet the Internet at Blue Cross and Blue Shield of Vermont is an independent corporation operating under a license with the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

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, Operating Rules 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, please visit