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Last updated on April 19, 2014 at 1:20 EDT

Softheon Helps Insurers Comply with PPACA-Mandated Summary of Benefits Coverage Deadline

July 6, 2012

HAUPPAUGE, N.Y., July 6, 2012 /PRNewswire/ — The Departments of Treasury, Labor, and Health and Human Services (HHS) have published a new enforcement guidance regarding the Patient Protection and Affordable Care Act (PPACA) requirement to distribute a uniform explanation of coverage. The proposed regulations require group health plans and health insurance issuers to distribute an easy-to-understand Summary of Benefits and Coverage (SBC).

With the recent decision of the Supreme Court to uphold the ACA, health plan insurers are overburdened with preparations to connect to Exchanges, including the very tight deadline to implement the new mandated SBC format by September 23, 2012. Softheon has the software product to hit the ground running and start implementing this solution immediately.

Softheon was recently awarded contracts by several health care payers, including one of the largest health insurers in the Northeast that serves several million members, to streamline the daunting task of implementing the new SBC format using the strict requirements laid out in the federal regulations.

“In light of the tight deadline and resource demands, we suspect many health carriers will face major challenges similar to this Northeast-based health plan issuer,” said Eugene Sayan, CEO of Softheon. “Carriers’ readiness to comply with the September 23, 2012 deadline is directly related to their current processes and the degree of automation in generating health benefit summaries. Health plan issuers using manual or homegrown systems that store data in disparate locations using various formats and systems will likely face even more data-related challenges.”

To be compliant by the PPACA-mandated deadline, health plan issuers must either implement new technology solutions swiftly or make costly adjustments to their current processes. As a result of the fast approaching deadline, many will be scrambling to put the right format in place, and may run the risk of integrating poorly with other processes which might introduce inefficiencies and errors.

Softheon is easing the burden of becoming compliant with the ACA-required changes for Summaries of Benefits and Coverage (SBCs) for healthcare payers nationwide.

Offered as part of the Softheon Exchange Connector(TM) platform, the solution helps insurers meet Plan Management requirements both near-term and long-term by providing a secure platform for managing templates, reporting, and summaries relative to SBC requirements, in addition to managing the certification and compliance monitoring of their Qualified Health Plans (QHPs) offered through Health Insurance Exchanges (HIX).

Some of the key features and benefits of the solution are the elimination of key-person dependencies, workflow bottlenecks, reduction of manual involvement and savings in expended resources. Organizations with complex business processes in place that require integration between multiple systems, such as claims or member portals, are invited to take the intelligent approach by considering the Softheon solution in order to save time, effort, and costs, and most importantly, to significantly reduce the risk of non-compliance.

Thought Leadership

Softheon Exchange Connector SBC Features

  • 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.
  • SBC workflow with web based user interface utilizing SOA, BPM, and ESB technologies for managing the creation, modification and termination of plan data.
  • Composite web services to support real-time plan data aggregation and dissemination between consumer portals, enrollment and core admin systems.
  • Direct fulfillment feed in PDF, HTML and XML in multiple language formats.
  • Rule based compliance monitoring to ensure PPACA provisions are met; i.e. SBC not willfully provided – $1000 per instance and $100 per day per individual for each day of noncompliance.

Robert Miller, Healthcare Reform Program Manager at Softheon

“Healthcare payers are feeling enormous pressures to implement provisions of PPACA; despite constrained resources, they must meet aggressive timelines. We are cognizant of health plan’s need to successfully participate in Health Insurance Exchange (HIX). 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”

About Softheon

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(TM) 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.

To find out more about the Softheon SBC, Exchange Connector, Softheon Business Connector, visit http://www.softheon.com/Site/solutions/exchange/plan-management

SOURCE Softheon, Inc.


Source: PR Newswire