MLR Regulations and Operating Margins

  • medium-two-doctors-computer-jpg-362x246Medical loss ratio (MLR) requirements pose new challenges for payers. These regulations require that group and individual health plans ensure that 80 to 85 percent of premium revenues are spent on healthcare services. Plans that fail to meet these standards will be required to give rebates to members. This intensifies existing pressures for payers to increase efficiency through automation. That’s where TriZetto can help.

    Improving administrative efficiency can help you comply with MLR requirements.


    To help you create a more efficient organization, TriZetto provides tools that automate processes in key aspects of the business. TriZetto’s scalable, flexible technology improves workflow processes, lowers staffing requirements and reduces costly maintenance and inefficient claims processing. Our Application Services, BPO Services and Consulting Services provide additional help for greater efficiency and savings.