CHICAGO, Dec. 5, 2012 /PRNewswire/ -- Softheon Inc., a leader in Health Care Reform Exchange solutions, announced today that they have released an updated cloud-based Qualified Health Plan (QHP) Certification solution as part of their Exchange Connector Plan Management platform. Softheon is getting Health Plans prepared for PPACA and helping them to connect with both Federally Facilitated Exchanges (FFE) and State-based Exchanges (SBE). Within Softheon's Plan Management solution, its QHP module supports interfaces between the health plan and the exchanges it operates in. Whether integrating with HIOS, SERFF, or any other communication protocol, Softheon ultimately provides a single interaction point for health plans during the certification, re-certification, decertification, appeals, and ongoing compliance monitoring processes.
The Softheon Exchange Connector (SEC) Plan Management solution has assisted several major health plans with some of the early PPACA mandates, including a real–time Summary of Benefits and Coverage (SBC) solution. Softheon generates an XML-based SBC repository containing relevant plan and rate information in order to produce uniform descriptions of coverage, including cost sharing, for each category of benefits identified. The SBC solution's composite web services are then able to support real-time plan data aggregation and dissemination between member and broker portals, enrollment and core administrative systems.
Along with their QHP and SBC solutions, Softheon's Exchange Connector™ platform also includes:
- A Small Business Health Options (SHOP) solution that provides real-time integration with respective exchange business areas to assist qualified small employers in enrolling employees in health insurance plans.
- An Eligibility & Enrollment solution that can significantly reduce the administrative burden that the health plans will experience during enrollment, thus allowing them to focus on customer care.
- A Billing & Financial Management solution that allows insured enrollees, federal agencies and health plan issuers to receive invoices and make payments, and provides a complete and transparent solution for all financial activities associated with the exchange.
- A Member Services solution that provides members with an easier purchasing experience, and enables health plan issuers to act as the first point of contact by offering easy access health coverage information and member services across multiple channels and mechanisms.
According to Softheon's Healthcare Reform Program Manager, Robert Miller, "Healthcare payers are feeling enormous pressures to implement provisions of PPACA; despite constrained resources, they must meet aggressive timelines. We are cognizant of a health plan's need to successfully participate in exchanges. Now, more than ever, insurers are looking for more efficient ways to effectively manage a wide array of business transformation efforts and simultaneously become more agile. Softheon is ready, with solutions that are ready to go."
Softheon, an emerging leader in next generation healthcare business process optimization, enables payer, provider, and government organizations to measurably reduce administrative cost, improve member and provider satisfaction, generate new revenue opportunities, and comply with regulatory statutes by adopting best business practices. The company does this mainly via its Softheon Exchange Connector™ platform, which serves as an intermediary between Carriers and Insurance Exchanges. Softheon is one of only two technology providers with operational experience in designing, implementing and supporting the nation's first state exchange, the Health Connector, in Massachusetts.
Softheon is currently attending the AHIP Fall Forum and Exchange Conference to educate and assist Health Plans with the upcoming challenges they are expecting to face. To find out more about the Softheon Exchange Connector or to request a demonstration, you can stop by their table or visit www.softheon.com.
SOURCE Softheon Inc.