Marketplace

Since the implementation of the Affordable Care Act, Softheon has built a configurable, rules based platforms to help health plans build a robust healthcare IT infrastructure. These solutions eliminate inefficiencies, promote collaboration, and provide visibility into insurance transactions and member activity.  As a SaaS and BPaaS platform, Softheon is trusted by over 60 healthcare payers to manage 37% of ACA lives. 

Decision Support and Anonymous Shopping

Softheon’s customizable anonymous shopping platform guides consumers to the plan that best suits their needs.  Using our best-in-class decision support tool, consumers can compare plan types, rates, deductibles, out-of-pocket maximums, provider and drug coverage, and much more. 

Benefits:

  • Decision Support
  • Enhanced Direct Enrollment (EDE)
  • Health Plan 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 carriers’ downstream core admin systems. Our fully-configurable EDI gateway can be customized to meet any health payer and exchange specifications.

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

Out of the box, Softheon’s platform contains configurable business rules based on federal, state and health plan specific requirements. These rules can be used to automatically manage any enrollment and payment scenarios, including terminations, cancellation, delinquency, and more. 

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 offers an integrated online & banking solution. Our customer-friendly billing experience allows you to manage financial transactions, premium payments & financial reconciliation. As an accessible PCI DSS 3.1 Electronic Payment platform, our solution 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 payment 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

Kevin Deutsch

Managing Director

Kevin is responsible for Softheon’s health plan cloud. From operations and product development, to customer satisfaction and growth, Kevin works with the health plan team to ensure the success of our health plan partners. Previously serving in Client Success, Kevin has developed significant industry experience through some of Softheon’s largest implementations and client relationship management. He received a dual bachelor’s degree in mathematics and computer science from St. Joseph’s College in Patchogue, NY. He can be reached by phone at (631) 682-9575 or email kdeutsch@softheon.com.

Clients

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