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Medical Loss Ratio Calculation Methodologies and Tools

Meeting the medical loss ratio reporting requirements is an entirely new and complex problem that cannot be solved with old tools and solutions. Only new cost information tools and methods that use modern, more powerful management science and technology will succeed.  You need an infinitely scalable program that will economically solve this problem with the accounting accuracy required.

There is no doubt that there will be fines assessed against some carriers that have met their loss ratio minimums but their cost reporting methodology failed to collect and calculate all of their eligible costs.

Will you be able to accurately calculate your medical loss ratios?

We're experts at building cost models in large, complex insurance operations. Our cost models report the incidence, time, and cost of all insurance enterprise activities. We've built our cost models throughout the US insurance industry since 1998, and in insurance companies from Japan to Kenya, Argentina to Bulgaria. No one delivers more accurate, more extensive, more useful,  and more affordable cost models in complex operations.  Our cost calculation methodology is the only one that the United States Federal government accepts for its own cost reimbursement programs. We guarantee our models will maximize your medical loss ratio.

We deliver Medical Loss Ratio cost models with AIM-Activity Information Modeling^TM, a powerful new business modeling methodology that incorporates statistical modeling and activity based costing methods. We invented AIM in 1998 and since them have built hundreds of cost models for insurance companies around the world. Having extensive global insurance financial modeling experience gives us an expertise that means there is nothing we haven't seen, blueprinted, calculated and modeled.

"Knowing our cost of activities, services, and customers has made a big difference in the way we design our services, plan, and manage our business.  AIM has made us all more effective"
Jim Karagiorgis, Sr. VP & Chief Transformation Officer, HIP Health Plan of New York

Your cost models will proof exactly to your general ledger and other regulatory filings. You will have unequivocal proof that every cent of your premiums and costs have been reported with audit trails in your medical loss ratio models.

"AIM is a unique and valuable tool for us. It delivers new information needed to make better decisions and achieve our goals."
Larry Agoglia, Managing Director & COO Citigroup Private Bank

Medical Loss Ratio Exhibits

Exhibit 1: Call Center Call Type Activity Cost Calculated For The Medical Loss Ratio

This MLR cost report is part of the activity cost model in a health insurance company's call center operation. It presents the activity cost of each type of call that the call centers handle. This model was assembled using AIM-Activity Information Modeling, Orient Point's proprietary methodology. It simultaneously collected, calculated, and modeled the total activities of more that 750 call center employees in three locations. This report is one of more than 100 charts and graphs that make up an Activity Information Model.