Softheon Marketplace Cloud to eliminate use of Healthcare.gov for real-time health plan enrollment

CMS-certified Enhanced Direct Enrollment (EDE) provides enrollment experience for ACA

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Apr 18, 2018, 01:06 ET

STONY BROOK, N.Y., April 18, 2018 /PRNewswire/ -- Softheon, a national leader in cloud-based health insurance exchange integration and services, announced today its private-label enrollment solution, which provides Enhanced Direct Enrollment-as-a-service (EDE); a unified enrollment experience and an updated, easy-to-use, portal for Marketplace members. EDE will eliminate the current "double redirect" to Healthcare.gov, 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.

Jane Good, former Executive Director for Aetna's Exchange program and founder of JGood Advisors said, "Softheon demonstrated their agility in a successful DE Proxy build in late 2017 and continues to shine as an early tester for Enhanced Direct Enrollment."

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. This also encourages the private sector to innovate, enable additional methods for consumers to enroll, provide better consumer experience, and leads to greater Marketplace stability, resulting from higher enrollments and issuer participation.

"Softheon recognizes the need for a better membership experience, and we are honored to partner directly with CMS to collaborate on Enhanced Direct Enrollment. This new method will reduce friction and allow members to stay on one site instead of going to multiple sites for messaging, notices, to make changes in eligibility, plans, and more - something that we have been advocating for since 2015," said Softheon Founder, CEO, & Chairman Eugene Sayan.

Softheon is a member of CMS's Direct Enrollment Partner Workgroup, a select team of issuers, web brokers, and third-party administrators who have been working closely with CMS technology, operations, and policy leads on Direct Enrollment enhancements. In late 2017, Softheon was a successful partner in DE Proxy, a CMS first-step in improving the member and agent/broker experience for Marketplace Open Enrollment.

"This is optimal for those without an Enhanced Direct Enrollment strategy," stated Bill Gaynor, Group Executive of Health Plan Solutions at Softheon. "With our Enhanced Direct Enrollment-as-a-service, insurers working with Softheon can be EDE-ready in a matter of minutes," Gaynor added.

Softheon, in partnership with Jane Good, detail the evolution of direct enrollment and its impact on policy management in their whitepaper: The evolution of the consumer experience in the Federal Marketplace: from classic Direct Enrollment to Enhanced Direct Enrollment. Download the whitepaper to learn more.

About Softheon
Softheon's mission is to make healthcare affordable, accessible, and plentiful. Softheon's cloud-based Software-as-a-Service (SaaS) and Business Process-as-a-Service (BPaaS) solutions for federal and state governments have solved complex challenges that are associated with administering public health insurance exchanges. Softheon solutions work to transform the way agencies operate by delivering unparalleled healthcare capabilities including but not limited to: Individual and SHOP Marketplaces, Special Enrollment Period (SEP) verification, Advance Premium Tax Credit (APTC) validation, Electronic Data Interchange (EDI) Validation, Electronic and Paper-based Payment Processing, Carrier Reconciliation Facilitation, and Federally Facilitated Marketplace (FFM) Population Analytics. In 2017, Softheon has been trusted by over 60 healthcare payers, serving 33% of lives on ACA.

SOURCE Softheon