As part of its Exchange Connector Plan Management platform, Softheon Inc., a provider of healthcare reform exchange solutions, has unveiled an updated cloud-based Qualified Health Plan (QHP) Certification solution.
The new module offers support to interfaces between the health plan and the exchanges in which it operates.
Health plan management is a series of business processes that allows issuers to efficiently manage the certification, recertification, decertification and compliance monitoring of their Qualified Health Plans (QHPs), provided with the help of Health Insurance Exchange (HIX).
Whether combining HIOS, SERFF, or any other communication protocol, Softheon finally offers a single interaction point for health plans during the certification, re-certification, decertification, appeals, and ongoing compliance monitoring processes.
The Softheon Exchange Connector (SEC (News - Alert)) Plan Management solution has helped numerous major health plans with some of the early PPACA mandates.
To create uniform descriptions of coverage, including cost sharing, for each category of advantages identified, Softheon produces an XML-based SBC repository that includes relevant plan and rate information.
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,” he said, “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.”
Recently, the company partnered with CSC to help healthcare professionals enhance efficiency and increase productivity. CSC (News - Alert) will deploy and offer the Softheon framework of business administration modules in a cloud environment.
According to the company, this will enable health insurance plans to enhance the features of their current system in a usage-based, Software-as-a-Service model.
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Edited by Braden Becker