Common use of Completion adjustment Clause in Contracts

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 Milliman’s 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. 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 Milliman’s ▇▇▇▇▇▇▇▇’▇ 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.