New offering simplifies compliance and member data sharing, automates consent, and supports enterprise-level privacy compliance across state and federal regulations

Edifecs, a Cotiviti business, today introduced its Member Consent Management solution designed to simplify and automate how health plans capture member consent and manage granular level data-sharing policies. Built for enterprise scalability, the solution enables secure, compliant, and timely data sharing of personal health information, according to each member’s consent preferences.

“Most payer organizations are still plagued with manual, decentralized processes. We’re able to help them improve the member experience while streamlining access to and sharing member data,” said Venkat Kavarthapu, executive vice president of Edifecs Operations for Cotiviti. “Maintaining compliance with electronic member consent is continuous and current methods lack visibility into the process and preferences. Member Consent Management is designed to help customers modernize their consent workflows, reduce manual effort, and stay ahead of rapidly evolving regulations.”

As members engage with multiple entities throughout their healthcare journey, the secure exchange of protected health information (PHI) becomes essential. Edifecs Member Consent Management is an efficient workflow solution that enables health plans to manage member consent while ensuring compliance with federal, state, Centers for Medicare & Medicaid Services (CMS), and enterprise data-sharing requirements. For example, Edifecs Member Consent Management supports payers’ need to comply with CMS-0057-F, which requires the capture of patient consent by opt-in or opt-out models. The solution also helps payers adhere to the U.S. Department of Health & Human Services 42 CFR Part 2 final rule, which prohibits sharing certain PHI without member consent.

As real-time access to member data becomes increasingly in demand, Edifecs Member Consent Management gives payers the tools to define, update, and enforce data-sharing rules. The fully electronic solution reduces administrative overhead, enhances compliance, and improves the experience for both members and internal users.

Key features of Edifecs Member Consent Management include:

• Capture and enforce patients’ privacy and data sharing preferences through an electronic, robust consent management portal
• Comply with all state and federal consent rules and regulations on privacy and data sharing
• Create complex, granular level policies for sensitive health information such as reproductive health, mental health, and substance abuse

This solution seamlessly integrates with Edifecs’ FHIR^® Gateway including the Payer and Provider access APIs, offering a unified approach to meeting interoperability demands while prioritizing members’ privacy and control. Built on an open architecture, it can be implemented as a stand-alone solution, allowing medical care services clients to integrate with any FHIR platform.

To learn more about Edifecs Member Consent Management, please visit: https://www.edifecs.com/products/member-consent-management.

About Edifecs

Edifecs, a Cotiviti business, provides market-leading technology to enable its payer and health system customers to unlock greater value with their healthcare operations solutions and data management platform, which includes its award-winning healthcare interoperability cloud solution. Edifecs healthcare SaaS solutions serve as the foundation that eliminates stakeholder friction to overcome healthcare’s biggest challenges, including accelerating value-based care adoption and obtaining more complete and accurate care funding. For more information, visit www.edifecs.com.

About Cotiviti

Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for over 300 million members and patients. Additionally, Cotiviti offers data management and recovery audit services to the retail sector to improve business outcomes. For more information, visit www.cotiviti.com.

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"Member Consent Management is designed to help customers modernize their consent workflows, reduce manual effort, and stay ahead of rapidly evolving regulations.”