Thought leadership

January 29, 2019

In the early days of the Patient Protection and Affordable Care Act (ACA), there was an expectation that most (if not all) states would establish a State-Based Marketplace (SBM). However, for several well-documented reasons, most states deferred to or relied on the Federally Facilitated Marketplace (FFM) for most – or all – of their Marketplace operations and information technology (IT).

August 16, 2018

The infographic gives an overview into the guardrails, application requirements, and state alterations the 1332 Waiver allows. Some details discussed include: state adoption and implementation, how the ACA’s basic protections will be retained, and the standards health insurance marketplaces must live up to.

August 7, 2018

The infographic discusses what reforms states can implement, what constraints states are under for changing Medicaid rules, and which states have approved or pending 1115 Waivers.

August 2, 2018

Softheon’s Asset Verification System, Verify, is the ‘first of its kind’ to certify both Health and Human Services (HHS) programs. Designed exclusively to detect fraud, waste, and abuse of enrollees and applicants while providing real-time identity confirmation, Softheon Verify™ combines robust data certification and a simple workflow to access and manage complex, varied Health & Human Services (HHS) eligibility and asset verification data. Download our solution overview to learn more.

July 26, 2018

Download our infographic and get the scoop on health savings accounts (HSAs). This infographic offers quick facts HSAs and offers insight into why Health Plans should begin viewing HSAs for members the same way employers view 401ks for employees; make contributions on their behalf.

May 4, 2018

Softheon’s Consumer Premium Bill Presentment, Bill Payment Index (CPBP2) report includes data from more than 60 commercial health and dental plans across 29 states, and measures bill presentment and transaction types including, but not limited to, print and mail fulfillment, electronic delivery, online (card and ACH), IVR (Card and ACH), Walk-in, and lockbox payments. The analysis represents over 3.2 million covered lives, or nearly 37% of the commercially insured U.S. population, under the Affordable Care Act, and more than $4 billion-member premium transactions in 2017.

Apr. 18, 2018

In our new whitepaper written by Jane Good, Founder, JGood Advisors, we will be discussing Enhanced Direct Enrollment (EDE). EDE is a unified enrollment experience that contains an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current “double redirect” to, using a series of CMS-based APIs to process eligibility and changes behind the scenes. This new portal will allow issuers and agent/brokers to establish and maintain relationships with members from initial enrollment, through mid-year changes, and into renewal. The goal of EDE is to provide consumers and health insurance brokers with alternatives to shop for and enroll in coverage, providing the data and tools needed to effectuate and maintain policies.

Feb. 1, 2018

This whitepaper provides an in-depth analysis of why the United States’ Centers of Medicare & Medicaid Services (CMS) Medicaid programs are undergoing major technological shifts. With the implementation of Medicaid Information Technology Architecture (MITA), states are struggling to move forward with integrations and configurations with technology. More specifically, this paper will discuss, the background of MMIS programs, MITA culture, integration and modularity, and lessons learned.

Feb. 1, 2018

Today’s administration of the small group market is burdened with cumbersome, manual processes and outdated technology. Paper-based enrollments and renewals slow down the process and leaves too much room for errors that further delays the sales cycle. Manual processes can be replaced with cloud-based digital solutions that integrate with a carrier’s current IT infrastructure. This datasheet demonstrates some ways Softheon can help address common challenges.

Jan. 16, 2018

In today’s digital era, government agencies are not just buying software, they are investing in higher levels of technology maturity for the enterprise. Softheon’s MITA-aligned, HIPAA compliant financial management service is the missing piece for state agencies looking to achieve this high level of technological maturity. This datasheet highlights the components of our Medicaid Administrative Cloud (MAC) platform.

Jan. 16, 2018

In 2017, we saw new technologies like Blockchain, Artificial Intelligence (AI), Machine Learning (ML) and the Internet-of-Things (IoT) make big advances across multiple industries. However, to date, we have yet to see them have a dramatic impact in healthcare. Will 2018 bring more of these innovative technologies to healthcare? Have a look at where we see these exciting new technologies going. Read the full predictions on Blockchain, Machine Learning, Artificial Intelligence, and Internet-of-Things (IoT).

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