Completion Factors. Milliman utilized 24 months of claims experience for the managed care population that was incurred through June 2006 and paid through May 2007 (eleven months of run-out). Milliman applied claim completion factors to the twelve months of SFY 2005 and twelve months of SFY 2006 claims experience. The claim completion factors were developed by service category based on utilization experience for the managed care population incurred and paid through May 2007.
Completion Factors. The cost reports contained claim experience incurred through December 31, 2006 and paid through December 31, 2006, as well as health plan estimated 1BNR reserve amounts. Milliman reviewed the claims completion contained in the submitted cost reports for reasonableness. During this review, Milliman estimated a high and low completion percentage on a statewide basis. The claims completion implemented by the health plans in aggregate was within the range and, as such, no further adjustments were applied.
Completion Factors. The AHCCCS DBF Actuarial Team developed completion factors to apply to the encounter data. Completion factors were calculated using the development method with monthly encounter data incurred from October 2019 through February 2024 and adjudicated and approved through the second encounter cycle for February 2024. The completion factors were developed by GSA, major COS and by month of service. The major COS are based upon the AHCCCS form type, which indicates the type of form used to submit a claim. AHCCCS has six form types: Professional and Other Services (form type A), Prescription Drug (form type C), Dental Services (form type D), Inpatient Hospital (form type I), Nursing Facility (form type L), and Outpatient Hospital (form type O). Dental Services (2.28% of CYE 23 payments) were combined with Professional and Other Services. Nursing Facility Services (0.95% of CYE 23 payments) were combined with Inpatient Hospital. The monthly completion factors were applied to the encounter data on a monthly basis. Aggregated CYE 23 completion factors by risk group, GSA, and rate setting COS can be found in Appendix 4. Table 6 below displays the aggregate impact of completion by GSA. North $368.17 $379.30 3.02% Central $388.33 $403.72 3.96% South $379.46 $391.85 3.27% I.2.B.iii.(c) Errors Found in the Data During the rate development process, it was determined that during the base data year (CYE 23) one Contractor overpaid a provider of air ambulance services, and another Contractor improperly calculated Medicaid paid amounts when involving coordination of benefits with Medicare and other third-party payers. To correct these submission errors, the CYE 23 base data was adjusted to account for revised health plan valued amounts. Table 7 below displays the aggregate impact of the encounter issue by GSA. North $379.30 $371.80 (1.98%) Central $403.72 $403.41 (0.08%) South $391.85 $391.39 (0.12%)
