For health plans & MCOs
Keep members covered, on the right side of the MLR.
Members churn at redetermination over paperwork, not eligibility. Mirza flags risk early, hands the state clean determinations, and structures the spend so your actuarial team can classify it as quality improvement, not admin.
For health plans & MCOs
You carry the retention risk.
Members churn at redetermination over paperwork, not eligibility, and it lands on your retention and quality measures. Eligibility authority sits with the state, so you can't fix it alone. Mirza runs the layer between you and the state.
See risk early
Flag members at risk of losing coverage before the deadline, not after they've churned.
Hand the state clean determinations
Audit-ready records instead of document chasing, in the format the agency needs.
Protect your measures
Defend retention and quality without needing authority you don't have.
For health plans & MCOs
Built for the right side of the MLR.
Mirza spend is structured to be classifiable as Quality Improvement Activity spend under federal MLR rules: on the medical side of the ledger, not admin. Per-member fees are tied to documented quality outcomes, care coordination, and patient safety interventions, each supported by a member-level audit trail your actuarial team can review before contract.
Administrative spend
Counts against your MLR
- ·Document chasing & mailings
- ·Call-center churn handling
- ·Re-enrollment marketing
- ·Manual verification staffing
QIA-classifiable spend
Counts toward your MLR, not against it
- +Member-level HEDIS attribution records
- +Care coordination & benefit navigation
- +Exemption identification before disenrollment
- +Health IT platform investment
● Mirza sits here: the medical side of the ledger
Classification you can defend
Quarterly HEDIS-mapped quality reports and an annual MLR QIA filing support package: the documentation your actuarial and compliance teams need to confirm classification before contract, and to stand behind it at audit.
Coverage that survives redetermination
Members with exemption signals (medical frailty, caregiving, pregnancy) are identified from data you already have, before a disenrollment notice goes out. Members who are subject to the requirement get reminders and cure-period support in their language and channel.
- ✓Live payroll and gig-platform integrations for work-activity evidence
- ✓Exemption identification from existing clinical and administrative data
- ✓SOC 2 Type II · HIPAA · BAA available
- ✓8-week deployment, layered on the systems you run
Fits your stack
Accelerate the systems you have. Don't replace them.
Mirza attaches to the eligibility systems, plan workflows, and integrator-led programs you already run, adding the verification, exception, and compliance layer on top. Each module deploys on its own: pick what your program needs, skip what you've already covered. Together they snap into one auditable benefits-continuity workflow.
Layer on, don't rip out
Ex parte verification, exception logic, and compliance records over your existing eligibility systems.
Make your integrator faster
Drop into integrator-led programs to accelerate H.R.1 readiness, with no procurement reset required.
Deliver where it lands
Structured output flows to agency systems, plan workflows, or your system of record, by API, file, or export.
Componentized by design
Work & income verification
Live payroll and gig-platform connections that verify work activity and income automatically, with ex parte evidence flowing straight into your eligibility workflow.
Clinical documentation intelligence
Surfaces the medical-frailty evidence the new standard requires, from clinical documentation no claims-based system can reach, delivered as a clean evidence feed.
Rules & exemption engine
Compliant, deemed compliant, excluded, or needs outreach: federal, state, and local rules as machine-readable, auditable logic, kept current as policy changes.
Outreach & cure-period workflows
Notices, reminders, and guided follow-ups in the member's language and channel. The outreach and cure obligations H.R.1 creates, automated.
Intelligent document processing
Reads submitted documents, checks sufficiency, and flags errors before submission, for cleaner evidence into whatever system you run.
Eligibility screening
A guided screen that determines what someone qualifies for in minutes, embeddable in the front doors you already run.
Common application
Collect once, apply to every program a household qualifies for, from 200+ supported, in a single pre-filled application, in under 15 minutes.