The inclusive experience your citizens are looking for
Softheon’s all-in-one platform offers everything you need to distribute Qualified Health Plans (QHPs) to your citizens. Offer more ways for your citizens to get coverage, including the individual market, SHOP, and HRA’s.
Trusted by CMS and 7 State Agencies
From shopping, eligibility, and enrollment to billing and payments, our end-to-end platform best serves you, your brokers, and your members.
Softheon’s Marketplace Cloud offers government-grade compliance with the private market.
Streamline enrollment and administration for your members and brokers.
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.
Eligibility & Enrollment
The entire eligibility process, including Advanced Premium Tax Credits (APTC), is completed in real-time.
Softheon automates the exchange of enrollment data between your core system and the government marketplace(s).
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.
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.
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.
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.
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.
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.
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.