Services / Core Actuarial & Pricing
Core Actuarial & Pricing
FSA/MAAA-certified actuarial services for Medicare Advantage, ACA, and Medicaid health plans.
Medicare Advantage Bid Development & Certification
- Complete CMS bid package preparation — Worksheets 1 through 5 (Parts A/B, Part D, supplemental benefits)
- Pricing actuarial memoranda and certification by FSA/MAAA in accordance with ASOP No. 25 (Credibility) and ASOP No. 56 (Modeling)
- Benefit design analysis, competitive benchmarking, and Part C/Part D revenue separation
- Post-bid reconciliation, variance analysis, and CMS bid audit support
ACA Marketplace Rate Filings & Pricing
- Individual and small group rate development with trend and morbidity projections
- Actuarial value calculations, metal-tier analysis, and induced demand modeling
- State rate filing preparation and regulatory liaison
- Experience rating, loss ratio development, and completion factor analysis
Medicaid Rate Setting & Review
- Capitation rate adequacy analysis and actuarial certification
- PMPM development, rate cell modeling, and acuity adjustments
- Managed care rate review and negotiation support
- Encounter data reconciliation and rate range testing
Premium Rate Development & Repricing
- Community and experience rating methodologies
- Manual rate development, claim triangles, and completion factor analysis
- Credibility blending (per ASOP No. 25) and rate smoothing
- Prospective and retrospective rate analyses with trend normalization
Product Development & Benefit Design
- New product feasibility analysis and market viability assessment
- Benefit design cost and utilization modeling
- Actuarial equivalence and actuarial value (AV) calculations
- Launch pricing, pro forma financials, and multi-year projections
Ready to get started?
Our actuaries are ready to support your next bid cycle or rate filing.