State-Based Marketplace Solutions
Free Staff to Focus on the Greater Mission of the Agency
Streamline insurance with an all-in-one platform that offers enrollment and automated back-end operational processes you need to distribute Qualified Health Plans (QHPs) to your citizens.
Distribute healthcare by offering comprehensive enrollment experiences by determining eligibility and premium tax credits prior to enrollment. Improve member retention by securing payment for premiums, improving carrier reconciliation, supporting member communication, and providing call-center activities.
Increase Enrollment and User Retention with Enhanced Consumer Experiences
Intuitive shopping is now a reality. Provide a customized plan shopping experience with decision support tools.
Provider & Pharmacy Lookup
Plan Shopping for Individual & Small Group Medical & Dental
Streamline and Automate Eligibility & Enrollment
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 Advanced Premium Tax Credits (APTC), is completed in real-time.
Simplify Payments by Empowering Your Members
Bypass third-party involvement by empowering members managing their digital wallets to support single and reoccurring payments. Supported payment methods include:
Credit and Debit Cards
ACH & e-Check
Voice payments through IVR
Shorten Catalog Upkeep Times with Rule-Based Configurations
Build and manage your health plan product repository with ease. Easily load your plans and rates, including associated plan documents while automatically validating plans and rates received through exchange enrollments.
Customize Data Ops & Intelligence and Review on One Platform
Easy access to user data in near-real-time reviewing transaction trends, member demographics, geography, financial information, and cost comparisons.
Save Time by Automating Data Governance
Automate 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.
Ensure Compliance with Pre-Established Correspondence
Effortlessly fulfill of all CMS required regulatory letters, as well as all other member touchpoints to enhance consumer engagement. Correspondence methods include:
Delinquency Notices & Appeals