STONY BROOK, N.Y., Dec. 17, 2015 /PRNewswire/ -- Softheon announced today that is has been recognized by this year's Fierce Innovation Awards: Health Payer Edition, a unique awards program from the publishers of FierceHealthPayer and FierceHealthcare. Softheon received top honors in the Data Analytics/Business Intelligence category.
The Fierce Innovation Awards recognize pioneering technologies and solutions that will transform the payer landscape. Winners were selected by a distinguished panel of payer executives. A complete list of judges can be found at https://www.fierceinnovationawards.com/healthpayer/2015#our_judges.
All applications were evaluated based on the following criteria: technological innovation, financial impact/value, competitive advantage, member experience/member outcomes, market need, and overall fierceness and innovation. Finalists were selected based on calculation of the judges' scores in each area.
Softheon is being recognized for its innovative, industry-leading product, Softheon Marketplace Connector Cloud (MC2).
"Softheon is honored to not only be nominated, but chosen as the winner of the Data Analytics/Business Intelligence Category for the 2015 Fierce Innovation Awards. At Softheon, we are passionate about data; it is our core competency and the cornerstone of our engagements. As we work towards disrupting the healthcare space, this recognition proves that all of our hard work has paid off, and it motivates us to continue pushing forward. Congratulations to the Softheon team!" said Eugene Sayan, Softheon CEO & Founder.
Recently, Softheon launched their Cost-Sharing Reduction (CSR) analysis and reconciliation solution, designed to reduce the administrative burden of Qualified Health Plans (QHPs). With tight guidelines proposed by the Centers for Medicare and Medicaid Services (CMS), Softheon predicts that CSR Reconciliation will become a significant pain point for issuers.
Softheon's expertise and track record of success with Edge Server and Baseline Reporting has been commended since receiving pass rates for 99% of carriers in 2015; a significant improvement in comparison to previous years. In fact, most CMS exceptions have been appealed by the carrier and overturned due to Softheon's data accuracy. In addition, Softheon's data reconciliation stretches beyond that of just enrollment data received from the insurance exchange marketplaces. Daily bank reconciliations are performed to ensure that transactions within Softheon's system successfully match up to funds deposited into client's custodial accounts, both through lockbox and merchant service processing channels. Automated processes have been put in place to assist in daily reconciliations, which encompass over 200,000 members.
Also, in response to Exchange Sustainability challenges, Softheon has announced the availability of Profit & Loss (P&L) big data and business intelligence for insurance carriers. With claims, enrollment, and payment data under one repository, Softheon is uniquely positioned to provide data analysis for financial oversight and sustainable business operations. Softheon big data and business intelligence provides health insurers with an executive dashboard that brings a visualization of data analytics including the following Key Performance Indicators:
- Member demographics (male vs. female)
- Age band (18-35 vs 55-63)
- County and Zip code geographical distribution
- QHP HIOS plan (most or least profitable ACA plan)
- Distribution channel (On vs Off Exchange)
- Broker book of business (profitability by demography or QHP)
All P&L reports provide drill down analytics with options to view data at a quarterly, monthly, and daily level, whereby insurers can determine the plans that contribute the least amount of revenue, etc. Claims analysis can also help reveal trends towards better utilization management, fraud, waste, and abuse anomalies among the providers with high claim payout for the same ICD/CPT code.
To learn more about Softheon, visit www.softheon.com
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Empowering the nation's first state health benefit exchange since 2008, Softheon's vision and strategic direction address healthcare payer, provider, and government agencies' goal of meeting Affordable Care Act (ACA) milestones. Softheon provides HIX Integration, Direct Enrollment, Premium Billing, and Edge Server solutions for insurance carriers of all sizes participating in Federal and State Health Insurance Exchange (HIX) Marketplaces. Softheon's Marketplace Connector Cloud (MC2) has been trusted by health plans, in all 50 states, as an accelerated federal, state, and private exchange integration platform. Softheon MC2 is a Software-as-a-Service (SaaS) solution where insurers pay a one-time activation and ongoing PMPM fees for exchange members only, while eliminating most, if not all, risks associated with ACA enrollment compliance and other mandates.