Softheon State Based Marketplace

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.

Why Softheon?

Trusted by CMS and 7 State Agencies

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 with the private market.

Customer Experience

Streamline enrollment and administration for your members and brokers.

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.


  • - 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


The entire eligibility process, including Advanced Premium Tax Credits (APTC), is completed in real-time.

Automated Enrollment

Softheon automates the exchange of enrollment data between your core system and the government marketplace(s).


  • - 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



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.


  • - 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


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.


  • - Electronic bill presentment
  • - Paper and paperless delivery
  • - Fulfillment
  • - Correspondence tracking reporting



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.


  • - 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.


  • - 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.


  • - 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.


  • - Enterprise Data Management & Warehouse Transformation & Monitoring
  • - Compliance Reporting
  • - Analytics Tools
  • - Referential Integrity

Data Governance


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.


  • - 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

Join Softheon

Trusted by CMS and 7 State Agencies