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Plan Catalog Management

Business Connector

Plan Catalog Management

Health Plans looking to participate in both Public and Private Exchanges must look to increase their efficiency while keeping their costs at a minimum. Softheon’s Plan Catalog Management is a solution to help Health Plans effectively connect with all types of Exchanges, while being compliant with the post ACA regulations.

Softheon’s Plan Catalog Management (PCM) solution will assist Health Plans to overcome several challenges they are facing with Patient Protection & Affordable Care Act (PPACA). Softheon’s PCM offers Health Plans the opportunity to utilize a single repository of Products and Plans to act as its source of reference. With this repository, Issuers will be able to reduce data redundancy and streamline their Qualified Health Plans (QHP) and Summary of Benefits & Coverage (SBC) processes.

Major Components of Softheon Plan Catalog Management include:

Centralized Repository of Products and Plans
- Create or modify products and plans
- Audit all changes to the data including version controls
- Export new or modified changes to existing products and systems
QHP Process
- Plan certification
- Plan compliance monitoring
- Monitoring changes in plan availability
- Plan recertification
- Plan decertification
SBC Process
- Data Capture & Normalization
- Secure and Flexible Framework to comply with strict SBC Regulations
- Automatic SBC Document generation and distribution
Rating Engine
- Real-time Rate calculations for instant online quotes
- Calculate multiple premium adjustments
- Any number of configurable rating factors (e.g. zip code, age and tobacco status)

Opportunities and Benefits

HIXs are major new, nationwide markets for health plans. Softheon Plan Catalog Management will present opportunities and benefits for health plan issuers, inlcuding:

Meet plan management formulary requirements and release regulated health plans in the individual and small group markets in real time
Leverage current processes and previously approved fillings to create and submit plans for QHP certification
Supply the full range of QHP data needed for certification and eventual inclusion
Respond to questions, objections and requests for additional questions from HIXs accordingly
Eliminate the need to enter or upload the same data in multiple places
Reuse company and plan components, such as networks and benefit structure
Strengthen local presence, improve relationships with state and community based organizations
Serve diverse, low and moderate income populations in a cost-effective manner

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Description

<div style="width: 540px; padding-left: 30px; padding-right: 30px;">
<p><img src="/HTMLCache/375/exchangeconnector.png" alt="Business Connector" style="border-radius: 20px; float: left;" /></p>
<div style="float: left; margin-top: 170px; padding-left: 20px; padding-bottom: 20px;">
<h2 style="width: 200px;"><span style="color: #66ccff;">Plan Catalog Management</span></h2>
</div>
<h3></h3>
<h3><span style="color: #66ccff;">Health Plans looking to participate in both Public and Private Exchanges must look to increase their efficiency while keeping their costs at a minimum. Softheon&rsquo;s Plan Catalog Management is a solution to help Health Plans effectively connect with all types of Exchanges, while being compliant with the post ACA regulations.</span></h3>
<p><span>Softheon&rsquo;s Plan Catalog Management (PCM) solution will assist Health Plans to overcome several challenges they are facing with Patient Protection &amp; Affordable Care Act (PPACA). Softheon&rsquo;s PCM offers Health Plans the opportunity to utilize a single repository of Products and Plans to act as its source of reference. With this repository, Issuers will be able to reduce data redundancy and streamline their Qualified Health Plans (QHP) and Summary of Benefits &amp; Coverage (SBC) processes.&nbsp;</span></p>
<p>&nbsp;</p>
<a href="javascript:void(0)" onclick="disable_scroll();$('#exchangeplanmanagementpopup').dialog({height: 650, width: 1200, scrollable: false, resizable: false, modal:true, overlay:{opacity:0.8,background:'black'}, close: function () {enable_scroll();}});"> <img src="/HTMLCache/375/PCM-BPMN-small.jpg" alt="Plan Catalog Management Workflow" style="display: block; margin-left: auto; margin-right: auto;" /> </a>
<h3><strong><span style="color: #808080;"><span style="color: #333333;">Major Components of Softheon</span> <span style="color: #66ccff;">Plan Catalog Management</span><span style="color: #333333;"> include:</span></span></strong></h3>
<ul>
<li><strong>Centralized Repository of Products and Plans</strong>
<ul>
<li>Create or modify products and plans</li>
<li>Audit all changes to the data including version controls</li>
<li>Export new or modified changes to existing products and systems</li>
</ul>
</li>
<li><strong>QHP Process</strong>
<ul>
<li>Plan certification</li>
<li>Plan compliance monitoring</li>
<li>Monitoring changes in plan availability</li>
<li>Plan recertification</li>
<li>Plan decertification</li>
</ul>
</li>
<li><strong>SBC Process</strong>
<ul>
<li>Data Capture &amp; Normalization</li>
<li>Secure and Flexible Framework to comply with strict SBC Regulations</li>
<li>Automatic SBC Document generation and distribution</li>
</ul>
</li>
<li><strong>Rating Engine</strong>
<ul>
<li>Real-time Rate calculations for instant online quotes</li>
<li>Calculate multiple premium adjustments</li>
<li>Any number of configurable rating factors (e.g. zip code, age and tobacco status)</li>
</ul>
</li>
</ul>
<h3><strong>Opportunities and Benefits</strong></h3>
<p>HIXs are major new, nationwide markets for health plans. Softheon Plan Catalog Management will present opportunities and benefits for health plan issuers, inlcuding:</p>
<ul>
<li>Meet plan management formulary requirements and release regulated health plans in the individual and small group markets in real time</li>
<li>Leverage current processes and previously approved fillings to create and submit plans for QHP certification</li>
<li>Supply the full range of QHP data needed for certification and eventual inclusion</li>
<li>Respond to questions, objections and requests for additional questions from HIXs accordingly</li>
<li>Eliminate the need to enter or upload the same data in multiple places</li>
<li>Reuse company and plan components, such as networks and benefit structure</li>
<li>Strengthen local presence, improve relationships with state and community based organizations</li>
<li>Serve diverse, low and moderate income populations in a cost-effective manner</li>
</ul>
</div>
<div id="exchangeplanmanagementpopup" style="display: none;"><img style="border-radius: 10px;" src="/HTMLCache/375/PCM-BPMN.jpg" /></div>

Click here to download the executive summary.
Deciphering the QHP Certification for Carriers Looking to Participate In Multiple State Exchanges

This presentation addresses the Qualified Health Plans (QHP) certification process and how multi-state carriers can participate in multiple exchanges.
Connecting with Private and Public Exchanges: Real World Examples

This presentation addresses the service and technology challenges for a health plan to compete successfully and efficiently in an individual and small group exchange market.