Common use of Provider Overpayments Clause in Contracts

Provider Overpayments. To the best of our knowledge, all information related to any payment recoveries not reflected in the base period encounter data was provided to us by the MCOPs in their survey responses, and the CY 2019 base data was adjusted to reflect any such recoveries. iii. Projected Benefit Cost Trends This section discusses the data, assumptions, and methodologies used to develop the benefit cost trends, i.e., the annualized projected change in benefit costs from the historical base period (CY 2019) to the CY 2022 rating period of this certification. We evaluated prospective trend rates using ODM data, as well as other internal data sources. Total benefit cost trends were developed on a PMPM basis consistent with prior years’ certifications. The trends are illustrated on a PMPM basis and primarily reflect utilization and mix/intensity of services. ODM-specific policy changes that impact CY 2022 provider reimbursement are handled through the program adjustments previously outlined.

Provider Overpayments. To the best of our knowledge, all information related to any payment recoveries not reflected in the base period encounter data was provided to us by the MCOPs in their survey responses, and the CY 2019 base data was adjusted to reflect any such recoveries. iii. Projected Benefit Cost Trends This section discusses the data, assumptions, and methodologies used to develop the benefit cost trends, i.e., the annualized projected change in benefit costs from the historical base period (CY 2019) to the CY 2022 2021 rating period of this certification. We evaluated prospective trend rates using ODM data, as well as other internal external data sources. Total benefit cost trends were developed on a PMPM basis consistent with prior years’ certifications. The trends are illustrated on a PMPM basis and primarily reflect utilization and mix/intensity of services. ODM-specific policy changes that impact CY 2022 2021 provider reimbursement are handled through the program adjustments previously outlined.