Modernizing Healthcare Payer & Provider Systems with HL7/FHIR, OMOP CDM, and Advanced EDI Integration

This session explores how modern healthcare organizations can streamline payer–provider data exchange, claims processing, and clinical interoperability using HL7/FHIR, OMOP CDM, EDI 837/835/270/271, and advanced integration frameworks. Attendees will learn how to unify clinical, financial, and administrative datasets into standardized models, automate eligibility and claims workflows, implement FHIR-based APIs, strengthen regulatory compliance (CMS, Medicaid, ACA), and modernize legacy systems such as QNXT, FACETS, and HealthEdge. Real-world case studies from Medicaid programs, payors such as Molina Healthcare and Florida Blue, and enterprise healthcare systems demonstrate how standardized data frameworks and integration patterns improve operational efficiency, accuracy, and patient outcomes.
Who is this presentation for?
Healthcare IT architects Business Analysts / Systems Analysts EDI/HL7 Analysts Medicaid/Medicare Program Teams
Prerequisite knowledge:

What you'll learn?

Parth Jani is a Senior Healthcare IT SME and Business Systems Consultant with extensive experience in Medicaid/Medicare programs, EDI transactions, HL7/FHIR integrations, OMOP CDM, revenue cycle management, and payer system modernization. With deep expertise in QNXT, FACETS, HealthEdge, Care Management systems, MuleSoft ESB, ETL tools, and enterprise healthcare data standards, Parth has led mission-critical healthcare transformation projects for state Medicaid programs, national payors, and provider networks. He excels in requirements gathering, system integration, payer compliance, clinical data exchange, regulatory initiatives, and program management across large-scale healthcare IT systems.