Health Insurance & Managed Care
PRODUCT DEVELOPMENT
RATE SETTING & FILING
Based on the current market and regulatory temperature, while maximizing profitability.
RISK ASSESSMENT
RISK ADJUSTMENT
Designed to help providers, health plans, and patients achieve better outcomes.
Capitation calculation and review
Evaluate capitation rates and provide actuarially sound advice and certifications.
Disease management support services
Effective approaches to improving patient outcomes including value-based care.
Provider reimbursement development and review
Evaluate and design reimbursement arrangements for maximum results.
Provider contracting support
Assisting and educating on contracting strategies and negotiations
State and Federal Regulators
The actuaries at NovaRest are best known for their expertise in healthcare reform, particularly with the Affofdable Care Act (ACA). Click the arrows below for detailed consulting services we provide for state and federal regulators.
- Review bids in accordance with Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS) guidance and professional actuarial standards
- Verify the underlying assumptions are reasonable and that they adequately support the overall bid
- Review the rate complaint and determine the level of review required for the particular circumstance
- Review rates in comparison to those of comparable products in the market place
- Review the financial statement of the insurance carrier to determine historic profit margins and financial strength, if provided
- Review the filing for completeness, consistency, and reasonableness
- Determination of compliance of any rate filings to statutory requirements
- Testify at rate hearings
- Health insurance reform review
- Mandated benefit impact analysis
- Actuarial Financial Examination support
- Audit Support
- Supervision and Receiverships support
- Rate Filing review
- Form A filing review
- Uninsured – State Planning Grant support
- Medicaid Upper Payment Limit calculation
