Health Consulting Services

Health Consulting Services to state and federal regulators by seasoned regulatory professionals skilled in managing audits, examinations, and investigations across the full spectrum of complex health insurance regulations and reforms.

Major Areas of Specialization

Compliance with the requirements of the Affordable Care Act (ACA)
Mental Health Parity and Addiction Equity Act (MHPAEA) specialist reviews
Review of Life and Health form filings for federal and state health regulations
Qualified Health Plan Certification Application Materials and Review Tools
Comprehensive and targeted market conduct examinations, including MHPAEA Compliance, Reproductive Health Benefits, Essential Health Benefits, Preventative Services Benefits
No Surprises Act (NSA) enforcement with a focus on qualifying payment amount (QPA) audits and overlapping specified state law
Transparency in Coverage data and the Claims Payment Policies
Network Adequacy reviews
Pharmacy Benefit Management (PBM) audits
Drug formulary and pharmacy claim reviews
Clinical Pharmacy-focused EHB, Clinical Appropriateness, and MHPAEA reviews
Training, audit design and development, and process improvement
Health regulation research projects for state and federal partners