Health Consulting Services

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The Health Consulting Services Division provides professional services to state and federal regulators. Our team is comprised of 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 form filings and qualified health plan application templates and tools for state and
    federal partners QHP Certification Application Materials
  • Targeted and comprehensive market conduct examinations
  • No Surprises Act (NSA) enforcement with a focus on qualifying payment amount (QPA) audits and overlapping specified state law
  • Audits of comparative analyses of nonquantitative treatment limitations (NQTLs)
  • Training on processes including prior authorization requirements for in-network and out-of-network inpatient services, concurrent review for in-network and out-of-network services, and standards for provider admission to a network (including provider reimbursement rates)
  • Pharmacy Benefit Management (PBM) audits
  • Formulary and pharmacy claim reviews
  • Pharmacy-focused mental health and substance use disorder parity reviews
  • Training, audit design and development, and process improvement
  • Health regulation research projects for state and federal partners
  • Transparency in Coverage

Our Health Consulting Services Team has the extensive regulatory, operational, clinical and legal experience necessary to solve the regulatory challenges that emerge in the continually evolving health landscape.

Division Leadership

Christine Thomas, MCMDirector

Christine comes to Examination Resources with more than 20 years of experience in insurance innovation, strategic…

Mitchell Ristine, JD, CIE, FAHM, MCMSenior Manager and In-House Counsel

Mitchell began his regulatory career in 2014 working with the Minnesota Department of Commerce as a…

Melinda Domzalski-Hansen, MCM, AIE, PAHMManager

Melinda Domzalski-Hansen has worked in the insurance industry for 20 years. For the first half of…

Caroline Bergh, CIE, MCM, FAHMSupervisor

Caroline began her career in insurance regulation and compliance at Examination Resources performing market conduct exams…

Chris Cagle, CIE, MCM, JDSupervisor

Chris is the Supervisor of the qualifying payment amount (QPA) Audit team and leads ER’s consulting…

Reba Leonard, CIE, CRMP, FAHM, MCMSupervisor

Reba Leonard has more than 30 years’ experience as an analyst, project manager, regulatory affairs consultant,…