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Your Assessment, Enrollment and Compliance Platform

Spend more time on your mission and less time managing vendors and their software. Softheon’s modular solutions are versatile, from enhancing new and legacy Medicaid systems to running an entire state-based exchange. A leader in health tech, we also track changing state and federal laws and policies so you don’t take risks with compliance.

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Government Solutions

Solutions that Simplify

It’s frustrating when your team has to manage multiple systems, new and legacy alike. Softheon’s solutions are built to purpose and designed to integrate into your existing technology or workflows. Simplify operations and get back your peace of mind.

Changing compliance requirements and multiple vendors can mean disaster in government-sponsored markets. But with Softheon, you get more than just tools; get the expertise that protects you. We work closely with CMS and often test proposed changes before they hit the market. Stay in compliance, maintain good relations with CMS, and reduce member abrasion.

Government Solutions

Get More Time,
See Less Risk

Softheon provides deep health tech expertise and comprehensive solutions to help government agencies simplify operations and make informed, data-driven decisions.


Medicaid Reassessment

Faster Decisions.

Quickly reassess your Medicaid populations for eligibility. Overnight batch processing lets you achieve CMS compliance while saving time and state resources

Medicaid Reassessment

Medicaid Enhanced Eligibility

Less Fraud

Protect your state from fraud, waste, and abuse. We enable integrations with state systems and automatically apply risk scores so you efficiently get the right applicants into the appropriate program.

Medicare Enhance Liability

State-Based Marketplace

Easier Enrollments.

Offer comprehensive enrollment experiences. Automated and user-friendly processes let you meet the health insurance needs of your residents while increasing operational efficiency

State-Based Marketplace

Federal Solutions

Better Operations.

Simplify complex health insurance processes. Partnering with an experienced technology vendor can help you mitigate operational issues and provide user-friendly services.

Federal Solutions

Softheon’s Government Solution
vs. Competitors

Government Solutions
Modern, CMS-compliant, configurable and flexible design to meet your state’s needs and satisfies legislative mandates.
Simplified billing with connections with down-stream payment sources and automated reconciliation No third-party Payment Facilitator needed Members can easily manage their digital wallets Supports single and recurring payments Meets CMS regulations Enhances consumer engagement
Eliminates need for multiple vendors Full-scope reporting available from shopping to member payments
Design may be standard and lack configurability options
Not typically included, or a subcontractor must be utilized
Administration siloed or lacking full visibility across member experience
Government Solutions
99% of data, including regional and small banks
Wider searches Can include SSN in search, or not Growing database of employers, can add employers of all sizes
Faster Returns Real-time web services calls Up to 60% of verifications in near-real-time
Highly configurable so all possible data partners are accounted for
99% of data, including regional and small banks
Not available
Returns take up to 14 days
Not available
Not available
Not configurable Instant search based on one data point Employer database focused on large employers
Not configurabile No follow-up
Not available

Why Health Plan Leaders
Trust Softheon

“Softheon was able to provide outstanding job training and outline a clear understanding of the work progress. Because Softheon leveraged the cloud to automatically scale to fit our product’s demands, we did not have to continually pay for extra space.”

Kelly Gunther | CIO, Connect for Health Colorado

“Softheon’s expert knowledge of the ACA marketplace coupled with their leading enrollment and billing technology has made them the perfect partner during Hometown Health’s first open enrollment period on the exchange.”

Jon Cain | CIO, West Virginia DHHR

“Our goal as an agency is to deliver to our members high-quality, efficient customer service that supports a broader variety of consumer needs. We are looking forward to the work with Softheon, so as to improve services for members and carriers.”

Louis Gutierrez | Executive Director of the Massachusetts Health Connector

RFP Guide for Eligibility Verification

Softheon poses relevant questions that government agencies must ask during the eligibility verification procurement process. Find the approach to eligibility verification that works for your agency.

Simplify Operations, Reduce Risk.

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