Delegated Risk Bearing Organization (RBO) Limited Medical Risk (LMR) Review Services

Description: Inland Empire Health Plan (IEHP) is seeking a qualified contractor to conduct a comprehensive review of the Medical Loss Ratio (MLR) reports for its delegated risk-bearing organizations (RBOs). The primary objective is to assess the accuracy and reasonableness of reported data specific to the Medi-Cal contract with IEHP and, if necessary, provide actionable recommendations for accurate MLR reporting by the RBOs. The contractor will also provide a detailed report for each RBO MLR file reviewed.

This project is crucial for ensuring IEHP meets Department of Health Care Services (DHCS) requirements for reviewing and overseeing delegated RBO MLR reports, as detailed in All Plan Letter 24-018.

The contractor will conduct a detailed review of each RBO's MLR filing pertaining to their IEHP line of business to ensure the reports accurately reflect the MLR experience for the calendar year. If material issues are identified, the contractor will advise IEHP and the RBO of the issue and recommend corrective actions.

The reports cover the calendar year 2024, and all reviews must be completed by November 30, 2025. Four delegated RBOs are subject to these MLR review and oversight requirements. Project closes May 30, 2025 2:00 PM PDT.