Common use of Completion for Additional Claims Clause in Contracts

Completion for Additional Claims. Run Out The base data includes claims incurred during CY 2012 and paid through June 2013. Xxxxxx analyzed the completeness by rating region and category of service (COS) in order to make the appropriate adjustments to the base data for claims incurred but not paid. Historical Program Changes In order to structure the historical claims data base appropriately, Xxxxxx reviewed prior rate setting documentation and other materials from the State to identify program changes that were implemented during the base data period. No mid-year adjustments were made in CY 2012 that materially impacted the ABD <21. Therefore, no historical program changes were made. ENCLOSURE 3 Projected Cost Development The adjusted base data (described in Enclosure 2) was brought forward to the contract period. The adjustments used to produce the projected costs are described within this section and listed below: • Impact of Medicaid Expansion/Those Eligible But Not Enrolled (EBNE). • Prospective Program Changes. • Trend.

Completion for Additional Claims. Run Out The base data includes claims incurred during CY 2012 and paid through June 2013. Xxxxxx Mercer analyzed the completeness by rating region and category of service (COS) in order to make the appropriate adjustments to the base data for claims incurred but not paid. Historical Program Changes In order to structure the historical claims data base appropriately, Xxxxxx Mercer reviewed prior rate setting documentation and other materials from the State to identify program changes that were implemented during the base data period. No mid-year adjustments were made in CY 2012 that materially impacted the ABD <21. Therefore, no historical program changes were made. ENCLOSURE 3 Projected Cost Development The adjusted base data (described in Enclosure 2) was brought forward to the contract period. The adjustments used to produce the projected costs are described within this section and listed below: • Impact of Medicaid Expansion/Those Eligible But Not Enrolled (EBNE). • Prospective Program Changes. • Trend.