Four Product Lines · PMPM Platform Engagement

Compliance now. Modernization on your timeline.

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.

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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
Try Public Tools
Transactional Services
Transactional Services
Per-call APIs for healthcare calculations. Designed for developers integrating into billing systems, TPAs, clearinghouses, and provider tooling.
Pay per use
free tier available · self-serve subscription in progress
What’s productized today
  • Claims Repricing API — paid tiers above the free tier
  • Pricing API — programmatic batch and streaming access
  • Rate metering and quota enforcement in place
Activation status
  • Engines, endpoints, and tier definitions are live
  • Consumer-grade signup and end-to-end checkout are fast-follow engineering
  • Contact for early access while activation completes
View API Pricing
Managed Data Services
Managed Data Services
Subscription services for healthcare data that changes constantly. Recurring value at a fraction of the cost of consultants or commercial vendors.
Custom subscription
productization in progress · pilot terms negotiated per service
Capabilities shipped today
  • State Medicaid compliance — TMPPM ingestion pipeline live; Florida AHCA next
  • CMS Fee Schedule Updates — quarterly RBRVS / OPPS / MS-DRG / NCCI
  • Provider Verification — NPPES, OIG/LEIE, PECOS, CAQH, state licensure scoring
  • Terminology Service — SNOMED ↔ CPT ↔ ICD with FHIR $translate
Productization status
  • Capabilities ship in code; subscriber-facing wrappers are in flight
  • TMPPM and Provider Verification are first to productize
  • Included for any Platform Engagement customer
Discuss Subscription
Platform Engagement
Platform Engagement
Payer-scale relationships across three layers: Foothold, Domain cutover, Core. Multi-year contracts.
PMPM
indicative within each layer · pilot-specific terms negotiated per engagement
Three layers
  • Layer 1 — Foothold (CMS-0057-F in your cloud; the core stays the system of record)
  • Layer 2 — Domain cutover (one operational domain off the core; reversible)
  • Layer 3 — Core (Cloud Health Office as the claims ledger, only when you choose)
Commercial shape
  • Multi-year contracts; expansion is an amendment, not a renegotiation
  • First production deployment terms available for an early production tenant in each layer
  • Indicative ranges available on request; pilot terms set per engagement
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Platform Engagement — three layers

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
Foothold
CMS-0057-F FHIR APIs in your Azure, AWS, or GCP this year. Your core stays authoritative, so the compliance spend is not a throwaway sidecar.
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.
Commercial shapeSmall annual subscription priced PMPM, weeks-to-deploy. Pilot-specific terms negotiated per engagement.
Where most payers start. Pilot-scoped entry point — an indicative PMPM starting range is shared during discovery, sized to your membership and CMS-0057-F scope. No platform-rebuild commitment required.
Layer 2
Domain cutover
Move one operational domain off the core without a rip-and-replace program. The core remains system of record for everything not cut over. Reversible.
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
Core
When, if ever, is Cloud Health Office the claims ledger? Only when you choose.
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. Ready for customer-owned validation with honest disclosure of remaining gaps (reference customer, scale testing, portal polish) discussed openly with pilot partners.
Commercial shapeLarger engagement, multi-year, priced PMPM. First production deployment terms reflect both the advantage of being first and the cost structure a cloud-native architecture supports.
A path, not a completed replacement. Layer 3 is not a claim that a live QNXT book has already moved, and not a big-bang HealthEdge-style program.

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.

Pricing Model
PMPM
scaled to your member count
All Engagements Include
Full Platform
no feature gates
Ready?
Contact Sales
sales@cloudhealthoffice.com

Core Admin Adapters

CHO connects to your existing core admin system through a defined adapter interface, so CMS-0057-F work does not require changing your legacy platform. Each core integration is scoped as engagement work: core system version, deployment topology, and configuration differ per payer, so the adapter is built to the specific environment rather than shipped pre-built.

QNXT
Adapter interface defined; integration built per engagement.
Per engagement
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. First production deployment terms are available for an early production tenant 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.

Ready to scope a CMS-0057-F pilot?

Talk about a deployment → Talk to Sales