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Calculating Medical Loss Ratio


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our 5 day evaluation pilot


Medical Loss Ratio Calculation Methodologies and Tools

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?

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 tools and methods that use modern, more powerful management science and technology will deliver the models you need at a cost you can afford.

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 ModelingTM, 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




























Learn about
our 5 day evaluation pilot

  Our medical loss ratio models deliver:
   Comprehensive cost measurements of every activity, process, product/policy type and customer segment.
      You must have this to prepare the MLR reports to every policyholder.

  The actual direct materials costs and indirect overhead costs consumed by every person for every activity.
      Your old FASB and SEC allowable cost allocation methods will under report your benefit costs.
  The cost and the cause of non-medical benefit activities and how to reduce them.

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.


Our No-cost 5 Day Evaluation Pilot

We offer a No-cost Evaluation Pilot that allows you to evaluate our approach, methodology, and technology. This pilot usually spans 5 days and delivers a set of cost models that will demonstrate the accuracy of our methodologies and technologies.

You'll see how we deliver more accurate, more extensive, more useful,  and more affordable cost models than any other method. We guarantee our models will maximize your medical loss ratio.

Your new problem requires a new solution.

Contact us at (631) 949-2300 or client.services@orientpoint.com


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