Most health plans engage Cloud Health Office through Platform Engagement — multi-year, payer-scale relationships priced per member per month (PMPM). We also offer Public Tools, Transactional Services, and Managed Data Services for developers, integrators, and small plans with specific data needs. Modernize now. Replace later.
Public Tools
Public Tools
Free utilities for healthcare data lookup and calculation. No signup, no credit card, no commercial conversation required.
Free
no commercial relationship required
What’s included
Fee schedule lookup — RBRVS, OPPS APC, MS-DRG with full RVU breakdown
Free-tier claims repricing — CMS-1500, UB-04, ADA
SEO-optimized utility pages with structured data
Same calculation engines that power Platform Engagement
Commercial shape
Free, usage-metered against the free-tier ceiling
Self-serve consumer signup is in progress — see Transactional Services
Each layer is a coherent offering on its own; each layer contains the previous. Customers enter where they are and expand on their timeline.
Layer 1
Compliance Accelerator
Who enters hereA payer locked into QNXT, HealthEdge, Facets, or a comparable legacy core, staring down the CMS-0057-F deadline, who needs a compliance surface stood up in weeks without a platform-rebuild project.
What’s includedPatient Access, Provider Directory, Prior Authorization (CRD → DTR → PAS), and Payer-to-Payer APIs. SMART-on-FHIR scope enforcement at the resource-type level. Ships as Helm into your existing Kubernetes cluster or Azure AKS. Read-mostly — your core admin remains system of record.
Who enters hereA payer frustrated with their legacy core’s license cost, innovation pace, or integration friction, with a CTO willing to commit to multi-year modernization only if the risk is contained one domain at a time.
What’s includedDomain-by-domain migration with per-tenant, per-domain operating mode — Augment (legacy authoritative, CHO calculates in parallel for comparison) or Replace (CHO authoritative, legacy off the critical path). Appeals is the lighthouse domain shipped end-to-end today.
Commercial shapeMulti-year, priced PMPM and per domain. New domains are amendments, not renegotiations.
Layer 3
Full CAPS Platform
Who enters hereMA startups and new-license plans with no legacy platform; small regional Medicaid plans whose existing platform cannot meet new requirements; mid-market commercial plans finishing a Layer 2 journey by turning their legacy core off entirely.
What’s includedThe full cloud-native CAPS — 36 services, 9 adjudication and rules engines, Argo-orchestrated adjudication pipeline, EDI ingress and egress (270/271/275/276/277/278/834/837), multi-tenant throughout. Production-ready today for new entrants; honest disclosure of remaining gaps (reference customer, scale testing, portal polish) discussed openly with pilot partners.
Commercial shapeLarger engagement, multi-year, priced PMPM. Founding-partner terms reflect both the strategic advantage of being first and the cost structure a cloud-native architecture supports.
Get a Quote
Platform Engagement is priced PMPM, indicative within each layer; specific terms are negotiated per pilot. Contact our team for a conversation scoped to your environment.
CHO connects to your existing core admin system through pluggable adapters — delivering CMS-0057-F compliance without touching your legacy platform. One compliance layer, any backend.
QNXT
Direct DB read replica, QNXT Open Access API, and QNXT Connect. PA submission via X12 278 into CareAdvance/UM workflow.
Available
CHO Native
Built-in adapter for CHO's own adjudication, benefits, enrollment, and authorization engines. Zero external dependencies.
Available
Facets
TriZetto Facets database integration with claims, enrollment, and authorization mapping. Direct DB and API access patterns.
Q1 2027
HealthEdge
HealthRules Payer REST API integration. API-first architecture makes this the cleanest adapter pattern.
Q1 2027
Generic DB
Configuration-driven adapter for any RDBMS-backed core admin system. Map your tables to CHO's domain model via config.
Q2 2027
Generic REST
Configuration-driven adapter for any API-first core admin system. Map your endpoints to CHO's domain model via config.
Q2 2027
Frequently Asked
Does CHO replace my existing core admin system?
Not unless you want it to. Most health plans deploy CHO in augmentation mode — it sits alongside your QNXT, Facets, HealthEdge, or other CAPS and provides the FHIR interoperability layer for CMS-0057-F compliance. Your core system continues operating as-is. Over time, you can activate modular capabilities and gradually reduce legacy dependency. Full standalone replacement is available when and if your organization is ready.
What does PMPM mean and how is it priced?
PMPM stands for per member per month — the standard unit economics for payer-scale platform relationships. CHO’s Platform Engagement is priced PMPM across all three layers. Pricing is indicative market-rate within each layer; specific terms are negotiated per pilot. Founding-partner terms are available for first pilot engagements in each layer. Layer 1 entry pricing is market-rate for CMS-0057-F compliance surfaces; Layer 2 PMPM expands per domain migrated; Layer 3 PMPM aspires to the range of incumbent CAPS platforms as production references accumulate.
Why are there four product lines? Can I use just one?
Yes — each product line is a coherent offering on its own. Public Tools, Transactional Services, and Managed Data Services do not require a Platform Engagement commitment. A developer can use the free fee schedule lookup forever; a TPA can subscribe to the Claims Repricing API without ever evaluating Platform Engagement; a Texas Medicaid plan can subscribe to TMPPM compliance updates while staying on its incumbent core. Customers move outward-to-inward over time when it makes sense for them — we don’t ask for a commitment to expand.
Which Da Vinci Implementation Guides does CHO conform to?
CHO implements C4BB (CARIN Blue Button) for ExplanationOfBenefit profiles, US Core for clinical resources, PDex for payer data exchange, PAS for prior authorization support, DTR for documentation templates, CRD for coverage requirements discovery, and HRex for payer-to-payer member matching. All four required APIs are validated against ONC Inferno test suites.
How does CHO handle X12 278 alongside FHIR PAS?
CHO includes a bidirectional X12 278 ↔ FHIR PAS translation bridge. Prior authorization requests can be submitted via either channel and route to the same processing engine. For augmentation deployments, PA requests are translated to X12 278 and routed into your existing UM workflow — your clinicians don't change how they work.
Can I switch from augmentation to standalone later?
Yes — and this is the path most health plans take. Start with augmentation mode to meet the January 2027 CMS-0057-F deadline on your existing core system. Then gradually activate CHO’s modular engines (adjudication, benefits, enrollment) as your legacy contracts expire or your modernization roadmap evolves. The transition is configuration-driven, not a rebuild. Modernize now. Replace later.
What if my core admin system isn't listed?
The Generic DB and Generic REST adapters handle any system with a relational database or REST API — you configure the mapping between your schema and CHO’s domain model. For proprietary or mainframe-based systems, custom adapter development is available for Platform Engagement customers with specific integration needs — contact sales for scope.