Broker

Softheon is a leading SaaS and BPaaS platform built to support brokers to  navigate their consumers through healthcare. A highly configurable cloud-based solution, Softheon manages decision support and plan shopping, integrations with multiple issuers as well as downstream core admin platforms. With the main goal of adding value to your clients, the Softheon platform enables brokers to optimize strategy, contain costs and simplify the administration process.

Decision Support and Anonymous Shopping

For brokers offering products directly to the consumer, Softheon offers a decision support and anonymous shopping platform to assist consumers in choosing the plan that is best for them. Using a combination of providers, drug formularies and demographic information, Softheon’s shopping experience is intuitive and easy to navigate while integrating with the exchange for subsidy validation through a health plan branded portal.

Benefits:

  • Decision Support
  • Enhanced Direct Enrollment (EDE)
  • Broker specific branding
  • Configurable rules for plan selection based on demographic information
  • Provider lookup and selection
  • Drug formulary integration
  • Broker assisted enrollment tracking

EDI Gateway

Softheon’s EDI gateway is responsible for the integration, data transfer and reconciliation between the health insurance exchanges and carrier downstream core admin systems. Through experience in the ACA and other markets, Softheon’s EDI gateway has been built to meet the specifications of nearly all companion guides and continues to expand.

Benefits:

  • EDI 834, 820, 837, flat file formats
  • SNIP validation
  • RCNI/RCNO reconciliation with CMS
  • Enrollment and Financial Reconciliation with state based exchanges
  • Enrollment Resolution and Reconciliation (ER&R)
  • Adherence to exchange and carrier core admin platform companion guides

Enrollment and Eligibility

Softheon’s platform comes standard with several built-in business rules which are configurable based on federal, state and health plan specific requirements. These business rules allow for automated processes to act on specific conditions and require others to pend for review prior to moving to the next step.

Benefits:

  • Configurable business rules
  • Termination, Cancellation and Delinquency management and processing
  • Member ID creation and management
  • Automation and manual review exception management
  • Special Enrollment Period (SEP) enrollment processing

Premium Billing and Presentment

Softheon’s premium billing & payment aggregation tool, Equity, offers an integrated online & banking solution that provides a customer-friendly billing experience while allowing you to manage financial transactions, premium payments & financial reconciliation. As an accessible PCI DSS 3.1 Electronic Payment platform, Equity serves individuals and brokers with multi-channel options, and offers the back-end processes needed to continually manage and track their payment statuses. To assist with higher membership retention, we support all payment types including credit cards, ACH & e-Check, and lockbox processing.

As a designated Payment Facilitator, we can also conveniently and quickly process payments without any third-party involvement. This prevents payments from building up and means we’re able to deliver outstanding service with unmatched reliability.

Benefits:

  • Online self-management
  • Electronic bill presentment
  • Multiple payments accepted
  • Credit & debit cards, including: Visa, MasterCard, American Express, and Discover
  • ACH & e-Check: Withdraw payments directly from a customer’s bank account without interchange fees
  • Lockbox processing: Collect and apply paper checks to the appropriate member account with regionally based lockbox processing hubs
  • Third-party payment detection with configurable processing procedures, helping to prevent against authorized sponsors from illegally obtaining higher reimbursement rates

Data Analytics

Softheon’s data analytics and reporting platform, Foundry, captures and tracks every member touchpoint, analyzing both their interactions and behaviors. Foundry’s reporting capabilities provide you with all the tools necessary to access and parse data from a high-level population overview down to an individual applicant.

Foundry BI, the solution’s business intelligence component, features configurable, state-of-the-art tools for non-technical users. Providing the ability to “slice and dice” data in near real-time, the reporting and business intelligence suite offers comprehensive analysis of transaction trends and key performance indicators (KPIs), including member demographics, geography and more.

Benefits:

  • Extract, Transform & Load (ETL) from multiple data sources to create custom reporting and analytics
  • Comprehensive ready to use out-of-the-box reporting
  • Compliance with HHS data submission and HIPAA requirements
  • Recovery: Back-up, restore, version, and recover capabilities
  • Service-level agreement (SLA) monitoring tools

Daniel Hughes

Managing Director, Broker Solutions

Dan is responsible for expanding relationships with new and existing customers, and improving the effectiveness of the sales team. Dan enjoys the opportunity to disrupt the industry and create new paths for a market that has been traditionally archaic, and paper driven. With Softheon’s ability to automate processes, we can streamline the experience and bring the industry into the modern era of technology. His goal is to communicate the new platforms Softheon is building and how it impacts specific market segments. He can be reached by phone at (631) 681-4027 or email dhughes@softheon.com

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