Softheon

Softheon Inc. (Softheon) is a United States technology company that provides a Medicaid Information Technology Architecture (“MITA”) aligned, Health Insurance Portability and Accountability Act (“HIPAA”), Payment Card Industry (“PCI”), National Institute of Standards and Technology (“NIST”) 800-53, Federal Information Processing Standards (“FIPS”) 140, and Minimum Acceptable Risk Standards for Exchanges (MARS-E), Version 2.0 aligned single-tenant Platform-as-a-Service (“PaaS”), Software-as-a-Service (“SaaS”), and Business Process-as-a-Service (“BPaaS”) cloud platform. The company works to solve complex health insurance distribution and service challenges for healthcare issuers, government agencies, brokers, employers, and consumers.

Softheon’s solutions transform the way state agencies, health plan issuers, brokers, and associations operate by delivering healthcare capabilities including: asset verification and identity proofing, individual, State-based, 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.

Integration with Healthcare.gov[edit]

In September 2019, the Centers for Medicare & Medicaid Services (CMS) approved Softheon as one of the leading Phase 3 Enhanced Direct Enrollment (EDE) vendors. Softheon’s private-label Marketplace-as-a-Service is an enrollment solution utilized by health insurance carriers to create a seamless enrollment experience for members seeking individual market coverage, including those seeking a tax credit, through the Affordable Care Act (ACA).  

Recognition[edit]

Softheon is a nationally recognized leader in its industry by Gartner, IDC, AHIP, ACAP, and HCEG. In 2018, Softheon was the 23rd fastest-growing company in the United States on Deloitte’s Technology Fast 500^[1]. In 2019, Softheon ranked as the 14th fastest-growing company on Crain’s New York Business Fast 50 list^[2]. Most recently, in 2020, Softheon ranked 1,595 on the Inc. 5000^[3], a list of the fastest-growing private companies in America.

Founder and History[edit]

Softheon was founded by Eugene Sayan in 2000, an IBM veteran who led big data and process management initiatives for Fortune 1000 companies, to develop innovative solutions for healthcare payers, providers, and government agencies^[4]. The company played a critical role in building the nation’s first state health benefit exchange for Massachusetts Connector (RomneyCare)^[5]. In 2008, Softheon was invited to design and implement the critical enrollment, premium billing, and CRM technology components of Massachusetts Health Connector Care^[6]. Softheon designed, developed, and set up the infrastructure, technology, tools, and services which resulted in a successful and efficient operation that exceeded Service Level Agreements set by the Health Connector.  

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