Softheon Assists Insurers with PPACA-Mandated Summary of Benefits Coverage Deadline [Professional Services Close – Up]

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.

According to a release on July 6

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. Softheon has the software product to start implementing this solution immediately.

Softheon was recently awarded contracts by several health care payers, including a health insurer in the Northeast that serves several million members, to streamline the 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, 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 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.

More information:

www.softheon.com

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