You design the health plans, we do the rest
Softheon’s vertically integrated platform offers everything you need to distribute Qualified Health Plans (QHPs) through the individual Marketplace. Keep your members engaged in a Quote-to-Card experience on your white-labeled site with our Phase 3 Enhanced Direct Enrollment (EDE) solution.
Why Softheon?
Partner with experts in the ACA Marketplace
One Platform
From shopping, eligibility and enrollment to billing and payments, our end-to-end platform best serves you, your brokers, and your members.
Built-in Compliance
Softheon’s Marketplace Cloud offers government-grade compliance to the private market in our NIST 800-53, FIPS-140, MARS-E 2.0, PCI, and HIPAA-compliant cloud.
Customer First
The customer is the priority. From the end-to-end experience to keeping their data secure, our customers and their members are our utmost concern.
Consumer Experience
Plan Shopping & Decision Support
We take a no wrong door approach to health insurance shopping with our white-labeled platform. The consumer is central in this streamlined approach to plan shopping, which features decision support, including PCP selection and drug lookup. Intuitive guided shopping is now a reality.
FEATURES
- - Plan Shopping for Individual & Small Group Medical & Dental
- - Decision Support
- - Provider & Pharmacy Lookup
- - Subsidy Estimator
- - Ancillary Products
- - Brand Management
- - Broker Portal & Support Tools
- - HRA Shopping Solution
Eligibility & Enrollment
Enhanced Direct Enrollment (EDE)
Through your white-labeled, health plan branded platform, you can offer an end-to-end enrollment experience to consumers in need of subsidized insurance. Connecting with CMS in real-time, Softheon is the only Phase 3 EDE Technology Provider capturing 100% of all enrollment scenarios without a need to redirect to healthcare.gov.
FEATURES
- - Enhanced Direct Enrollment (EDE) Phase 3
- - Back-end enrollment processing for Individual & Small Group
- - Termination, Cancellation & Delinquency management & processing
- - Off-Exchange support
- - Member identifier matching logic
- - Automated business rules including exception handling
- - Special Enrollment Period (SEP) enrollment processing
Payments
Wallet
We offer a full-suite PCI DSS 3.1 payment/banking platform that connects with all major card brands and other payment channels (cash, money orders, etc.), including Fiserv and MoneyGram, to support our issuers. As a designated Payment Facilitator, we can also quickly and conveniently process payments without any third-party involvement. Members can manage their digital wallets to support single and reoccurring payments.
FEATURES
- - Digital wallet functionality
- - Credit & debit cards, including: Visa, MasterCard, American Express, and Discover
- - ACH & e-Check
- - Lockbox processing
- - Third-party payment detection and fraud prevention
- - One-time and recurring payments
- - Voice payments through IVR
Correspondence
Member Communications
Presentment and fulfillment of all CMS required regulatory letters, as well as all other member touchpoints to enhance consumer engagement, can be delivered in either paper or paperless documents.
FEATURES
- - Electronic bill presentment
- - Paper and paperless delivery
- - Fulfillment
- - Correspondence tracking reporting
Finance
Accounting
Softheon finance allows you to track subsidies, member discounts/incentives, and track/pay agent and broker commissions with fully integrated accounting functions. Additionally, managing general ledger and month/year-end closing has never been easier with a full suite of financial reports.
FEATURES
- - Premium Billing
- - A/R management
- - Agent/Broker commissions
- - Subsidy tracking and management
- - Financial Reporting
- - Member loyalty programs & incentives
Product & Pricing
Plan Management & Rating
Softheon Product & Pricing allows you to build and manage your health plan product repository with ease. We utilize CMS standard and non-standard formats to load your plans and rates, including associated plan documents. The product repository also contains built-in rules to validate plans and rates received through exchange enrollments.
FEATURES
- - SERFF & Non-SERFF file validation and processing
- - Product Repository
- - Rate Verification
- - Plan document storage
- - Service area management
- - Ancillary products
Payload Management
EDI Gateway
Softheon Payload Management allows you to integrate with the Federally Facilitated Marketplace (FFM), all major State-Based Marketplaces (SBMs), and your claims administration platform without changing your existing infrastructure. We facilitate data exchanges through secure, real-time APIs, as well as standard and ad-hoc file types, including EDI 834, 820, 837, XML, CSV, etc.
FEATURES
- - EDI processing
- - SNIP validation
- - Secure File Transfer
- - Real-time APIs
- - Exchange and claims administration integration
- - Data integrity & Normalization
Data Intelligence
Softheon’s data intelligence suite offers intuitive state-of-the-art tools for all members of the health plan from the C-Suite to the individual contributor. Users can analyze data in near-real-time reviewing transaction trends, member demographics, geography, financial information, and cost comparisons.
FEATURES
- - Enterprise Data Management & Warehouse Transformation & Monitoring
- - Compliance Reporting
- - Analytics Tools
- - Referential Integrity
Data Governance
Reconciliation
Softheon Data Governance manages all facets of reconciliation, from enrollment and financial data, through the Exchanges and core admin platforms. Our system features a fully automated RCNI/RCNO process with Enrollment Resolution & Reconciliation (ER&R) dispute generation and processing.
FEATURES
- - FFM RCNI/RCNO reconciliation
- - SBM reconciliation
- - Core admin platform reconciliation
- - Enrollment Resolution & Reconciliation Dispute (ER&R) generation and processing
- - Edge Server management
- - Cost Share Reduction (CSR) Reconciliation