Medicaid

With Medicaid Expansion and 1115 waivers becoming more prevalent, Softheon has built a Medicaid Cloud to support health plans manage enrollment processing, premium billing and presentment as well as reconciliation. Through configurable business rules, the Softheon platform adapts to everchanging state requirements to ensure adherence to stringent SLAs and compliance. 

Enrollment and Eligibility

Softheon’s enrollment and eligibility platform has been developed to sort through and normalize the Medicaid data that is passed from the states to determine eligibility requirements to pass through to the invoicing and payment collection step. This process has been optimized to meet the Service Level Agreements (SLAs) required by the state from an accuracy and timeliness perspective.

Benefits:

  • EDI 834, flat file formats
  • State and carrier reconciliation
  • Adherence to state and core admin platform companion guides
  • Configurable business rules to meet state and carrier specific requirements
  • Payment Interface file creation to track member status

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:

  • Add generation and delivery of Payment Interface files including payments and invoices for state reporting purposes
  • Fast Track payment processing

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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