Services / Strategic & Compliance
Strategic & Compliance
Financial strategy, appointed actuary, regulatory guidance, and M&A due diligence.
Financial Forecasting & Budgeting
- Annual and multi-year financial projections with scenario modeling
- Medical loss ratio (MLR) reporting and 80/85% threshold rebate calculations
- Reserve and IBNR calculations using completion factor and development triangle methods
- Margin and profitability analysis by product line, county, and plan type
Appointed Actuary & Financial Reporting
- Statement of Actuarial Opinion (SAO) preparation per ASOP No. 36
- NAIC annual and quarterly statement actuarial support
- Risk-Based Capital (RBC) analysis and C-1 through C-4 component review
- Actuarial certification for state DOI filings and rate reviews
Regulatory Impact Assessments
- CMS final rule impact modeling (e.g., rate notice, Part D redesign, risk model updates)
- State regulatory change analysis and DOI filing support
- ACA Section 1332 waiver and MA regulatory compliance review
- CMS audit preparation (VBID, D-SNP, C-SNP model of care)
Provider Network & Contract Analytics
- Fee schedule benchmarking (Medicare, commercial)
- Network adequacy and access analysis
- Contract alternative rate modeling
- Shared savings and value-based contract design
Mergers, Acquisitions & Due Diligence
- Actuarial due diligence for health plan acquisitions
- Liability and reserve adequacy review
- Business integration financial modeling
- Regulatory approval support for transactions
Compliance & Readiness
HIPAA
Support for HIPAA-aligned PHI handling and data security workflows.
CMS Medicare Advantage Regulations
Deep expertise in MA bid, encounter data, and audit requirements.
ACA & Market Reform Rules
Individual, small group, and large group market regulatory expertise.
21st Century Cures Act
Interoperability and information blocking compliance support.
SOC 2 Trust Services Criteria
Security control practices aligned to SOC 2 trust services criteria.
Navigate complex regulations with confidence
Our compliance team stays current with CMS rule changes so you do not have to.