Reducing the Cost of NAIC MAR Compliance

Precisely Uses Automated Analysis to Rein in Compliance Costs for a Leading Health Insurer

As one of the largest customer-owned health insurance companies, this organization offers a variety of health, life and related insurance products through its plans, affiliates and subsidiaries. In order to provide superior services and products to its individual members and group customers, this organization embarked on a journey to achieve operational excellence in all of its core business processes.

In an effort to support its board’s mandate to comply with Sarbanes-Oxley (SOX) and National Association of Insurance Commission’s Model Audit Rule (NAIC MAR), the organization looked to identify and mitigate information risks in their critical business processes. NAIC MAR, also known as Annual Financial Reporting Model Regulation, applies to all insurance carriers with written premiums over $500 million. It is similar to the Sarbanes-Oxley Act of 2002 but requires management certification instead of external auditor certification.

The Challenge

In partnership with its internal and external auditors, the healthcare payer first identified all critical financial applications and information exchange interfaces in claims, payments, membership, actuarial, finance and accounting. External and internal audit reviews identified 77 financially critical interfaces for NAIC MAR compliance. Of those, 39 were identified for further assessment based on their risk profile.

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