Common use of Development of Projected Benefit Costs Clause in Contracts

Development of Projected Benefit Costs. (a) Description of the data, assumptions, and methodologies Step 1: Create per member per month (PMPM) cost summaries Step 2: Apply data quality adjustments Step 3: Apply historical and other adjustments to cost summaries Step 4: Adjust for prospective program and policy changes and trend to calendar year 2020 Other material adjustments - managed care efficiency Emergency Room Inpatient Hospital Maternity Delivery Kick Payment (b) Material changes to the data, assumptions, and methodologies (c) Overpayments to providers

Development of Projected Benefit Costs. (a) Description of the data, assumptions, and methodologies Step 1: Create per member per month (PMPM) cost summaries Step 2: Apply data quality adjustments Step 3: Rate cell reassignment Step 4: Apply historical and other adjustments to cost summaries Step 45: Adjust for prospective program and policy changes and trend to calendar year 2020 2019 Other material adjustments - managed care efficiency Emergency Room Inpatient Hospital Maternity Delivery Kick Payment (b) Material changes to the data, assumptions, and methodologies (c) Overpayments to providersHospital

Development of Projected Benefit Costs. (a) Description of the data, assumptions, and methodologies Step 1: Create per member per month (PMPM) cost summaries Step 2: Apply data quality adjustments Step 3: 1634 conversion rate cell reassignment Step 4: Apply historical and other adjustments to cost summaries Step 45: Adjust for prospective program and policy changes and trend to calendar year 2020 2018 Other material adjustments - managed care efficiency Emergency Room Inpatient Hospital Maternity Delivery Kick Payment (b) Material changes to the data, assumptions, and methodologies (c) Overpayments to providersefficiency

Development of Projected Benefit Costs. (a) Description of the data, assumptions, and methodologies Step 1: Create base period per member per month (PMPM) cost summaries Step 2: Apply retrospective base data quality adjustments Step 3: Apply historical and other adjustments to cost summaries Step 43: Adjust for prospective program and policy changes and trend to calendar year 2020 Other material adjustments - managed 2024 Step 4: Incorporate non-benefit items and adjustments Step 5: Composite nursing facility level of care efficiency Emergency Room Inpatient Hospital Maternity Delivery Kick Payment(NFLOC) rating cell (b) Material changes to the data, assumptions, and methodologies (c) Overpayments to providers

Development of Projected Benefit Costs. (a) Description of the data, assumptions, and methodologies Step 1: Create base period per member per month (PMPM) cost summaries Step 2: Apply base data quality adjustments Step 3: Apply historical and other adjustments to cost summaries Step 43: Adjust for prospective program and policy changes and trend to calendar year 2020 2018 Step 4: Incorporate non-benefit items and adjustments Step 5: Composite nursing facility level of care (NFLOC) rating cell Other material adjustments - managed care efficiency Emergency Room Inpatient Hospital Maternity Delivery Kick Paymentefficiency (b) Material changes to the data, assumptions, and methodologies (c) Overpayments to providers