Softheon Partners with AHIP to Provide Health Plans with an Accelerated Health Insurance Marketplace Connector

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Dec 10, 2013, 02:37 ET

STONY BROOK, N.Y., Dec. 10, 2013 /PRNewswire/ -- Softheon, Inc., a proven leader in real-time edge computing platform for Health Insurance Marketplace Integration, today announced a new partnership with America's Health Insurance Plans (AHIP) to help health plans transition to the new marketplace. Through this arrangement, Softheon's Health Insurance Marketplace platform for enrollment, premium billing, and plan management will be available to AHIP health plan members.

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Remaining at the forefront of Health Insurance Marketplace Integration, Softheon notably recognizes and addresses the concerns voiced by health plans across the country, striving to participate during open enrollment. Lessening the burden placed on carriers at this crucial time, Softheon will assist AHIP members validating the commitment Softheon's dedicated team has continually provided to its health plan partners in over 40 states.

"One of the biggest problems of the transition to a Health Insurance Marketplace model is that it involves many IT applications, architecture, and related activities. It can be even more complex on the business side of the enterprise," stated Eugene Sayan, Founder and CEO of Softheon. "Recently over 35 health plans have chosen Softheon SaaS platform and BPO services to virtually eliminate all risks associated with FFM and SBMs integration. We are excited to work with AHIP to bring our services to their member health plans."

As the leader in Health Insurance Marketplace Integration, Softheon avidly strives to assist healthcare payers differentiate their business practices among other carriers. Through this arrangement, Softheon will remain true to this commitment, offering the on-boarding services required by The Centers of Medicare and Medicaid Services, for AHIP members with approved QHPs. Timely implementation and successful launch of this health plan marketplace program is guaranteed for those that meet this prerequisite.

"FFM and SBM on-boarding processes would require extensive technology investment and business resources by health plans. We are pleased to provide our members with access to Softheon's cloud-based SaaS platform and BPO services to help them succeed in the new marketplace," said Brendan Miller, Vice President of Business Development at America's Health Insurance Plans.

Recently, Softheon completed initial CMS connectivity and carrier wave testing, successfully effectuating marketplace members with multiple carrier core systems, including TriZetto QNXT, DST Amisys, HealthEdge, ikaSystems, and EPIC. This milestone, along with Softheon's uniquely qualified and nationally acclaimed rapport, has provided the expertise and industry knowledge necessary to embark on this venture with AHIP.

Quotes & Commentary

"CIOs who invest in scalable, flexible enterprise systems that are configured to respond to changing healthcare needs have the ability to participate in a wide variety of new opportunities."*

"Cloud computing offers healthcare payers an alternative for implementing cost prohibitive applications due to high resource demand or expensive hardware investment. While cloud computing will require new skills and training, it offers an opportunity to experiment with new products and more quickly capitalize on new market opportunities,"** noted Christina Lucero, Gartner

"Marketplaces are the ultimate source of consumer empowerment, because they allow consumers to make both cost based and, eventually, quality-based decisions concerning the healthcare services they purchase. Healthcare payers and their CIOs must understand this new dynamic, because this new consumer empowerment will drive fundamental changes in the marketing and delivery of products,"** wrote Robert H. Booz, Gartner

Supporting Resources

*Top Actions for Healthcare Payer CIOs, 2013: Ensure Core System Readiness for Post-reform Era, Robert Booz, Published: 24 January 2013
**Hype Cycle for Healthcare Payers, July 2013, Robert Booz, Published: 23 July 2013
Gartner Research

About AHIP

America's Health Insurance Plans (AHIP) is the national trade association representing the health insurance industry. AHIP's members provide health and supplemental benefits to more than 200 million Americans through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality and innovation.

About Softheon

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 solutions for interacting with Federal and State Health Insurance Exchange (HIX) Marketplaces, while measurably reducing administrative costs, improving member and provider satisfaction, as well as addressing regulatory compliance challenges in all managed care administrative processes.

Softheon's Marketplace Connector Cloud (MC2) has been trusted by over 35 health plans 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 compliance of 2014 enrollment and other mandates.

To find out more about the Softheon, visit www.softheon.com.

SOURCE Softheon, Inc.