The 6 CMS Approved Enhanced Direct Enrollment (EDE) Vendors for Carriers
EDE is critical to the growth and retention of membership in the ACA Marketplace. Make your evaluation process easier and compare all the CMS approved EDE vendors that support carriers.
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EDE Vendors for Carriers
We reviewed the CMS Entities Approved to use Enhanced Direct Enrollment, business websites, and other credible online sources to identify the six EDE vendors that support Carriers. We also spoke to our customers and prospective customers about the other EDE vendors they evaluated to understand their needs.
See how Softheon’s Carrier Platform with Enhanced Direct Enrollment compares to other EDE vendors so you can choose the best vendor for your health plan.
| Softheon | HealthTrio / Online Insights | Jet Health Solutions | BenefitAlign | HealthSherpa | Stride Health | ||
| Product Lines Supported | On-Exchange | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ |
| Off-Exchange | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | |
| Dental | ✔️ | ✔️ | ✔️ | ||||
| Vision | ✔️ | ✔️ | |||||
| Small Group | ✔️ | ✔️ | ✔️ | ✔️ | |||
| Medicare | ✔️ | ✔️ | ✔️ | ||||
| Functionality Supported | Shopping | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ |
| Enrollment & Business Rules | ✔️ | ✔️ | ✔️ | ✔️ | |||
| EDI | ✔️ | ✔️ | ✔️ | ✔️ | |||
| Billing | ✔️ | ✔️ | ✔️ | ✔️ | |||
| Communications | ✔️ | ✔️ | |||||
| PCI Payment Processor | ✔️ | ||||||
| Member Portal | ✔️ | ✔️ | ✔️ | ✔️ | |||
| Broker Portal | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | ||
| Commissions | ✔️ | ✔️ | ✔️ | ✔️ | |||
| Sponsor Portal | ✔️ | ||||||
| Financial Reconciliation | ✔️ | ✔️ | ✔️ | ||||
| Reporting | ✔️ | ✔️ | ✔️ | ✔️ | ✔️ | ||
| AI & Predictive Analytics | ✔️ | ||||||
Get a copy of the vendor comparison chart
Why do growing Marketplace health plans need to use EDE?
In the early days of the Affordable Care Act, member acquisition efforts were primarily driven by HealthCare.gov and state-based marketplaces. As health plans have learned the market, they have re-entered or entered the market for the first time, and competition has increased. Health plans have become much more active, leveraging their broker network and going direct to consumer.
Using an Enhanced Direct Enrollment vendor allows your health plan to control the customer experience by removing the competition and ensuring your plans are the only ones seen by prospective members.
What other criteria and features should you consider when choosing an EDE vendor?
Depending on the lines of business’ your health plan supports, take into consideration:
Customer Experience – Supporting multiple lines of business with Softheon, means you can create a single customer experience across business lines, enabling easier cross selling abilities, transferring between programs, and increasing brand loyalty.
ACA as a New Line of Business – If you are just entering the ACA, you need a strategic partner, not just a technology vendor. Softheon’s 20 plus year of experience makes us the most experienced ACA vendor who truly understands the ACA and has the experience to support and help you enter the ACA in as little as 60 days.
I thought there were more than six vendors. What about the rest?
There are other vendors but they either serve other markets (GetInsured serves government SBMs), are no longer supporting EDE for carriers (GuideWell), or are a subsidiary of another company (W3LL, subsidiary of Softheon).
Why Softheon's Carrier Platform?
Scale existing or enter new markets at warp speed, capitalizing on the synergies created by serving the three government markets - Medicaid, Marketplace, and Medicare. Create a branded experience through the whole enrollment process improving your ACA individual market business.
Grow Your Membership
Enable and optimize all sales channels and deliver a seamless application and renewal process. Softheon's white labeled Carrier Platform will help your health plan:
- Increase new membership
- Increase effectuation rates
- Increase retention rates
Accelerate Your Operations
Automate the complicated connections and workflows around the enrollment process and make sure your members have quick access to care. Softheon’s Carrier Platform helps your health plan:
- Reduce operating costs
- Reduce time to market and implementation costs
- Reduce the annual audit burden
Optimize Your Outcomes
With one of its many applications, Softheon’s Carrier Platform predicted with over 80% accuracy, the members who were likely to have their plan lapse during the year. Health plans have used this information to create interventions in partnership with their broker community to increase retention.
What Our Customers are Saying
The implementation here has been really strong. [Softheon has] a fantastic solution and its performance has been great. I think the challenge for solutions like Softheon is you basically start as a Software as a Service Solution but when you're in this business you have to start bolting on some business process outsourcing like mail fulfillment and other parts of that. So, you look for a solution that has the Software as a Service down but also is pretty well buttoned up on the BPO piece too because you're going to need both if you're going to do this eligibility enrollment piece. You can't get up and running without the pipes into HealthCare.gov and they have some pretty good pipes here.
Trusted by Over 90 ACA Health Plans Across the Country
Learn How Softheon Can Help Your Health Plan Grow
You know an EDE Vendor will benefit your business and now you know what to look for when choosing a partner.
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Product Descriptions
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Online anonymous shopping, plan selection, and plan application process.
Management of enrollment spans, grace period logic, policy changes, renewals, and agent management.
Sending, receiving, and ingesting EDI files from health plan and CMS.
Support all financial management and premium billing scenarios.
Invoice generation and communication about enrollment through mail, email, and text message.
Collect premium payments through ACH, Lockbox, Credit, and Debit.
Portal where members can log in and see their plan selection, make SEP changes to their plan, review their balance, and make payments.
An EDE enabled broker portal where brokers can enroll and manage their members in your plan.
Generate commission reports based on membership and broker association so that payments can be made to the broker network.
Third Party Payment portal that allows non-profit provider sponsored plans to help pay for a member’s premium.
Automated financial reporting to improve accounting operations including Accounts Receivable Aging, Premium Payment Recognition, APTC Received v. Expected, and other critical financial information.
Track operational activities in real time through standard and custom reporting.
Leverage the robust data sets from enrollment, claims, and SDOH to help improve outcomes, maintain coverage, and increase revenue.