Completion adjustment. The capitation rates are based on CY 2018 experience. Encounter data is paid through March 31, 2019. Completion factors were developed by summarizing encounter data and applying traditional actuarial techniques to develop estimates of incurred but not paid (IBNP) liability, using Milliman’s Robust Time-Series Analysis System (RTS)2. First, we stratified the data by category of service and population grouping. Claims for each of these population- service category stratifications were analyzed and formed into lag triangles by paid and incurred month. Claim completion factors were developed for each month of the base experience period, based on historical completion patterns. Completion factors developed through the use of encounter data were compared to MCP reported IBNP liability estimates in the CY 2018 MCP Cost Reports for reasonableness. The monthly completion factors were applied to CY 2018 experience to estimate the remaining claims liability for the calendar year. Results were aggregated into annual completion factors for each calendar year.
Completion adjustment. 3.2 On the date falling seven (7) Business Days prior to the Completion Date (the "Pro Forma Completion Accounts Date"), the Seller shall provide the Buyer and APG with:
Completion adjustment. The capitation rates are based on CY 2016 experience. Encounter data is paid through March 31, 2017. Completion factors were developed by summarizing encounter data and applying traditional actuarial techniques to develop estimates of incurred but not paid (IBNP) liability. First, we stratified the data by category of service and population groupings. Claims for each of these population-service category stratifications were analyzed and formed into lag triangles by paid and incurred month. Claim completion factors were developed for each month of the base experience period, based on historical completion patterns. Completion factors developed through the use of encounter data were compared to MCP reported IBNP liability estimates in the CY 2016 MCP Cost Reports. The completion factors selected were developed by blending MCP reported IBNP with our IBNP estimates. The monthly completion factors were applied to CY 2016 non-sub-capitated experience to estimate the remaining claims liability for the calendar year. Results were aggregated into annual completion factors for each calendar year. For the AFK population, completion factors were developed through a review of historical fee-for-service claims experience.
Completion adjustment. 7.7 The adjustments (if any) to be made after Completion to the 3 Italia Estimates and the Wind Estimates shall be calculated on the basis set out in Part 1 of Schedule 10.
Completion adjustment. The capitation rates are based on CY 2019 Opt-In program experience. Encounter data is paid through June 30, 2021. In recognition of the 18 months of available runout to the CY 2019 incurred period, we asked the MCOPs to provide updated IBNP estimates for this period as part of the MCOP survey process. Additionally, completion factors were developed by summarizing encounter data and applying traditional actuarial techniques to develop estimates of incurred but not paid (IBNP) liability, using Xxxxxxxx’x Robust Time-Series Reserve Analysis System (RTS)2. First, we stratified the data by category of service. Claims for each of these population-service category stratifications were analyzed and formed into lag triangles by paid and incurred month. Claim completion factors were developed for each month of the base experience period, based on historical completion patterns. Completion factors developed through the use of encounter data were compared to MCOP reported IBNP liability estimates in the MCOP surveys. Based on our review of historical claim payment patterns and prior rate development analyses, we elected to apply completion adjustments based on IBNP liabilities reported by the MCOPs.
Completion adjustment. 3.3.1 The Buyer and the Seller shall agree and/or there shall be determined the Completion Adjustment in accordance with Schedule 7.
Completion adjustment. The capitation rates are based on SFY 2021 Experience Adjusted data. The unadjusted encounter data used to develop the Experience Adjustment was adjudicated through December 31, 2021. As part of the Experience Adjustment, completion factors were developed by summarizing encounter data and applying traditional actuarial techniques to develop estimates of IBNP liability, using Milliman’s Robust Time-Series Analysis System (RTS)6. First, we stratified the data by category of service in the population groupings. Claims for each of these population-service category stratifications were analyzed and formed into lag triangles by paid and incurred month. Claim completion factors were developed for each month of the base experience period, based on historical completion patterns. Completion factors developed using encounter data were compared to MCO- reported IBNP liability estimates in the CY 2020 and Q4 2021 MCO Cost Reports for reasonableness. The monthly completion factors were applied to unadjusted SFY experience to estimate the remaining claims liability for the period.
Completion adjustment. The CY 2015 cost report data submitted by the MCOPs includes 12 months of incurred claims, with 3 additional months of claims payments. We developed IBNP adjustments by MCOP and Major Service Category (Inpatient, Outpatient, Nursing Facility, Physician, Pharmacy, Waiver Services, and Other). An identical process was used to develop completion adjustments for the YTD June 2016 cost report data. The YTD June 2016 cost report data included no additional months of claims payments subsequent to the January 1, 2016 through June 30, 2016 incurred period. Consequently, the resulting factors have greater probability of variation from actual incurred claims and the YTD June 2016 cost report data was relied upon in limited manner. The May 1, 2013 through April 30, 2014 FFS data reflected 26 months of claims runout and was assumed to be fully complete.
Completion adjustment. The Purchase Price will be adjusted by the Completion Adjustment by way of a decrease to the Purchase Price (if the amount of the Completion Adjustment is positive) or by way of an increase to the Purchase Price (if the amount of the Completion Adjustment is negative).
