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Pay Per Member. Not Per Feature.

Simple per-member-per-month pricing that scales with your health plan. No transaction caps. No feature gates. Every tier includes the full platform.

Open Source
$0 forever
Self-hosted · Unlimited members
  • Full platform source code
  • All 17 microservices
  • All X12 EDI transactions
  • All FHIR R4 APIs
  • Argo Workflows adjudication
  • BSL 1.1 license
  • No managed hosting
  • Community support only
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Growth
$0.75 PMPM
Up to 50,000 members
Example: 20K members = $15,000/mo
  • Everything in Open Source
  • Managed SaaS hosting (Azure)
  • Single clearinghouse connector
  • Portal access
  • BAA included
  • Email support (4hr SLA)
  • 99.5% uptime SLA
  • 30-day free trial
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Scale
$0.45 PMPM
Up to 250,000 members
Example: 75K members = $33,750/mo
  • Everything in Growth
  • Multi-clearinghouse failover
  • Prior auth automation (278/CDS)
  • Medical attachments (275/RFAI)
  • Dedicated onboarding engineer
  • Slack + phone support (1hr SLA)
  • 99.9% uptime SLA
  • Custom workflow configuration
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Enterprise
Custom PMPM
250,000+ members
Volume-based pricing from $0.25 PMPM
  • Everything in Scale
  • Volume-based PMPM discount
  • Dedicated CSM + TAM
  • Hybrid / on-premise deployment
  • White-label portal
  • Custom core admin integration
  • 99.99% uptime SLA
  • Annual or multi-year terms
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Estimate Your Monthly Cost

Drag the slider or type a number to see your estimated monthly cost.

50,000
$22,500/mo
$270,000 per year
Scale tier · $0.45 PMPM
Save $1.2M+ vs. a typical core admin upgrade
Based on average $1.5M cost for core system CMS-0057-F compliance projects

Every Tier Includes the Full Platform

No feature gates. No module upsells. You get everything.

Claims Processing

837P/I/D inbound, claims scrubbing (20+ rules), 10-step adjudication workflow, 835 ERA generation. Sub-500ms processing.

Eligibility

Real-time and batch 270/271 eligibility verification. Member, coverage, and benefit plan management.

Prior Authorization

278 request/response, CDS Hooks for coverage requirements discovery. CMS-0057-F Prior Auth API.

Medical Attachments

275 inbound, RFAI case management, 277 status, 824 acknowledgment. Automated document correlation.

FHIR R4 APIs

Patient Access, Provider Access, Payer-to-Payer, Prior Auth, Provider Directory. Full CMS-0057-F compliance.

Multi-Tenant Portal

Blazor Server portal with 37 pages. Dashboard, claims, eligibility, members, providers, workflows, benefit plans.

Enrollment

834 enrollment import. Member, subscriber, dependent, and sponsor management. Coverage lifecycle tracking.

EDI Infrastructure

17 Argo Workflows for automated EDI processing. SFTP polling, Kafka event-driven, multi-clearinghouse routing.

Security & Compliance

HIPAA-grade infrastructure. BAA included. Zero known vulnerabilities. 531 tests, 85.93% coverage. Audit trails.

How CHO Compares

Capability Legacy Core Admin Cloud Health Office
CMS-0057-F compliance $1.5M–3M upgrade + 12–18 months Included · Live in weeks
Typical annual cost (50K members) $500K–2M/yr maintenance $270K/yr ($0.45 PMPM)
Claims adjudication speed 7–14 day turnaround <500ms real-time
Clearinghouse lock-in Single vendor, 3-year contract Multi-clearinghouse failover
FHIR R4 APIs Add-on module ($200K+) Included · 5 production APIs
Deployment time 12–18 months Weeks (integration) to months (full)
Source code access Never BSL 1.1 · Full source access
Contract terms 3–5 year lock-in Month-to-month or annual

Frequently Asked Questions

How is "member" counted for billing?
We count unique enrolled members with active coverage in your system as of the first of each month. This is the same member count you report to CMS or your state regulator. Dependents and subscribers are both counted. We pull the count from your enrollment data — no manual reporting required.
Is there a minimum commitment?
Growth and Scale plans are month-to-month with no minimum term. Cancel anytime. Enterprise plans offer annual or multi-year terms with additional PMPM discounts. All paid plans include a 30-day free trial.
What if my membership fluctuates seasonally?
Your bill adjusts automatically each month based on your enrolled member count. Medicaid MCOs with seasonal redetermination cycles or Medicare Advantage plans with AEP enrollment spikes only pay for the members they have that month. No true-ups, no overages.
Are there any transaction limits or overage charges?
No. Every paid tier includes unlimited EDI transactions, unlimited FHIR API calls, and unlimited claims processing. Your PMPM covers everything. We don't charge per transaction, per claim, or per API call.
Does this replace our core admin system?
It can, but it doesn't have to. Most health plans start by using Cloud Health Office as an integration layer alongside their existing core admin (QNXT, FACETS, HealthEdge, etc.) for EDI modernization and CMS compliance. Every component is designed to either augment or replace the corresponding module — you choose which workloads to migrate and when.
Is a BAA included?
Yes. Every paid tier includes a signed Business Associate Agreement. The self-hosted tier requires your own BAA framework.
Can I start with the self-hosted version and upgrade later?
Absolutely. Many organizations evaluate under the non-production use grant, then move to a managed tier when they're ready for production. Your data and configuration migrate seamlessly — it's the same platform.

Ready to See What It Costs for Your Plan?

30-day free trial. No credit card required. Production-grade from day one.

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