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Focus on the Greater Mission

You’re striving for the best care for your residents while dealing with change. Softheon has an all-in-one platform that offers a streamlined member experience and AI-powered back-end processes that you need to distribute Qualified Health Plans (QHPs) to your citizens. 

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Never compromise on care

Distributing healthcare in the face of changing regulations can be difficult. The more resources spent meeting modern technology standards distracts from what really matters: the people you serve. 

State-Based Marketplace Solutions

More and happier members 

Increase enrollment and retention rates by offering a seamless and enhanced member experience. Members enrolling on the ACA Marketplace often don’t always have the luxury of one-on-one attention. Give them the next best thing. A personalized shopping, billing, and self-service experience guides most members so you can focus on the rest. 

Discover how AIME, Softheon’s generative AI solution, guides members during plan shopping and post-enrollment.
State-Based Marketplace Solutions

Guide Your Members. Intuitive shopping is now a reality. Provide a simple and customized plan shopping experience with decision support tools.

State-Based Marketplace Solutions

Simplify Payments. Bypass third-party involvement and call-center backlogs by empowering members to manage their digital wallets. Have the built-in technology to support single and reoccurring payments through a variety of channels. 

Streamlined processes that scale

Softheon handles all back-end enrollment processing, carrier interactions, and financial-management operations, so you don’t have to. The entire eligibility and enrollment process, including the Advanced Premium Tax Credits (APTC) calculation, is completed in real-time through AI-powered workflows.

State-Based Marketplace Solutions

Shorten maintenance times. Easily load your plans and rates, including associated plan documents, while automatically validating plans and rates received through enrollments.

State-Based Marketplace Solutions

Easy Data Governance. Automate all facets of reconciliation from enrollment to financial data. Softheon’s system features a fully automated RCNI/RCNO process with Enrollment Resolution & Reconciliation (ER&R) dispute generation and processing.

Take the stress out of compliance

The needs of the state and federal regulators are always shifting. Softheon’s close relationship with CMS and Exchange experience starting with RomneyCare allows us to adapt to changes without disturbing your members. 

State-Based Marketplace Solutions

Flexibility to Change. Adapt to the changing group insurance landscape and capitalize on 1332 waiver opportunities with a flexible approach to integration. Move beyond a patchworked Medicaid rules engine with Softheon’s Exchange-specific platform that bends and scales to your needs. 

State-Based Marketplace Solutions

Communication Handled. Let Softheon fulfill all CMS required regulatory letters, as well as needed member touchpoints.

Marketplace Shopping, Enrollment, and Billing RFP guide for Health Plans

Understand what questions health plans must ask during the procurement process to secure robust and scalable shopping and enrollment solutions.

See how smarter automation scales growth and cuts costs.

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