Will North Carolina Expand Medicaid?

In the face of several states expanding Medicaid, and with citizens this past week in Idaho rallying for a “clean implementation” of the expansion without any restrictions, it is worthwhile to consider whether North Carolina will be joining their ranks. The state’s governor, democrats and a handful of its republicans have been striving for two years to extend coverage to non-elderly adults with incomes up to 133% of the federal poverty level, despite a republican house and senate. Recent changes in the legislative makeup from the November 2018 election, in addition to other pressures, however, provide fuel for the fight to expand. 

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3 Ways Telehealth is Redefining Modern Healthcare

With continuing advancements in healthcare technology, telehealth has transitioned from a luxury to an essential part of the consumer experience. The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. The growth of virtual care has created a seamless integration of convenience from patient to doctor and vice versa. Healthcare practices, companies, and representatives are rapidly grasping this concept and making progress in 2019.

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A Break with Precedent: Decreased Exchange User Fee Rates

As a continuation of our previous analysis describing the implications of HHS’ recently released Proposed Notice of Benefit and Payment Parameters (NBPP) for 2020, we have done a deeper dive into one of the NBPP’s biggest proposed changes: the decreased user fee rates on exchanges. 

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Implications of HHS’ Proposed 2020 Notice of Benefit and Payment Parameters


The U.S. Department of Health and Human Services (HHS) released its annual Notice of Benefit and Payment Parameters for 2020’s proposed rule earlier this month. According to the Center for Medicare and Medicaid Services (CMS), the annual notice updates guidance and regulations related to issuers and Exchanges. 

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Normalization: Not so Normal

One of the biggest struggles in EDI 834 processing is understanding the different ways each exchange sends their files. For example, the FFM can send a code from their file that symbolizes something different than the NYS Health Exchange code. This makes processing files through the same system very difficult, until Softheon found a way to unify the data.

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Go Beyond the Cloud with Timothy Williams

Meet Tim Williams, our Helpdesk Technician and United States Army 25N, Joint Nodal Networks Systems Operator/Maintainer.

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Every Product Needs Empathy

Empathy is one of the most widely discussed topics in product design and user experience in the healthcare industry. As technology rapidly develops, it has several impacts on consumer care. In terms of healthcare products, applying empathy means having the ability to understand and uncover what people need and implementing what we discover.

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How Social Media is Revolutionizing Healthcare

Social media is a global phenomenon transforming the way people consume information, research, and news. In the United States, 196 million people used multiple social media platforms in 2016 and a forecasted 216 million will join by 2021. Included in these populations are healthcare professionals utilizing social networking and publishing tools to share their knowledge. On the opposite end are millennials looking for on-demand healthcare advice and treatment. 

With doctors and nurses making this information readily available, social media is quickly revolutionizing healthcare. According to ReferralMD, “More than 40% of consumers say that information found via social media affects the way they deal with their health.” 

Here’s a close look at how social media is changing the way people perceive, consume, and internalize healthcare. 

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Open Enrollment 2019 is Over – What’s Next?

Softheon’s 2019 Open Enrollment period has been one of the most successful to date. Before November 1, we made significant updates to our processes, including increasing the throughput of enrollment records and reducing manual work. These updates resulted in faster turnaround for consumers. Now that Open Enrollment is over, all issuers should be focusing on membership retention. This is especially important considering the individual mandate, which required individuals to obtain health insurance or face tax penalties, is no longer applicable. Conducting outreach to members will help but, what else can an issuer do to increase the retention?

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