The largest component of a rating algorithm is the network.  Since the late 80s, MRM has been on the forefront of evaluating managed care and preferred provider organizations. MRM has analyzed over 400 networks nationwide and provides pricing solutions to nearly half of the stop loss industry.  In fact, we are the recommended source for network evaluations by one of the nation’s leading actuarial consulting firms that license stop loss pricing tools.  Health plans and providers come to MRM for help understanding their stop loss liability, and we strategize on ways to help minimize that liability.  For more information on our network evaluation tools or other network subjects, contact Jennifer Unsworth or Linda Pruitte

MRM is the industry leader in providing an array of superior Underwriting Services. Our highly experienced Underwriting staff has an average tenure of over 20 years of Stop Loss expertise. Leverage this expertise in a review of your underwriting practices. We can take a look at your existing workflow, offer expert opinion on risk selection philosophy, or simply give you an outside perspective on your current guidelines.

Manual rating, experience rating, or community rating. Whatever your approach is, let MRM evaluate your approach relative to the market. We’ve helped carriers understand how their rating approach may expose them to adverse selection. Health plans, reinsurers and direct carriers frequently seek guidance from MRM actuaries. Is it time for an outside perspective on your pricing approach? We’re here to help.

Let the experienced clinicians at MRM dive into your large claim data to provide written summaries on an individual and collective basis for risk assessment to assist your underwriters in pricing quotes. Our nurses combine their clinical view, along with analytical tools that assess costs by geography and network, to determine reasonable estimates of proposed treatments including costly drug therapies. We can identify diagnoses of concern for claims that may be emerging while the quote is in process, but have not generated a high claim.  For example, a patient being treated for spinal muscular atrophy may be receiving pain management treatment (less than $50,000) but could be eligible for a high cost treatment like Spinraza ($750,000). Our nurses understand stop loss contracts, which allows them to communicate the risk profile to the underwriter.  Have a discussion today with our lead nurse Karen Cunningham

Regulatory compliance can be complicated but it doesn’t have to be. MRM performs customized rate filings for state compliance as one of our many services for client partners. The standard package includes a certified actuarial memo, description with examples of the manual rating algorithm, and a collection of all rating tables used for risk adjustment.