Predictive Modeling. Contractor shall utilize claims and CCCD to risk stratify the population and to identify high-risk conditions requiring immediate Care Management.
Predictive Modeling. The Contractor shall have a predictive modeling and health risk stratification engine that the Contractor will use to proactively identify high-risk Enrollees and monitor gaps in care.
Predictive Modeling. Upon availability of Enrollee claims data.
Predictive Modeling. The Contractor shall utilize claims and care coordination claims database (CCCD) data and have a predictive modeling and health risk stratification engine that the Contractor will use to proactively identify high-risk Enrollees, identify high risk conditions needing immediate care management, and monitor gaps in care.
Predictive Modeling. 2.7.3.1 The Contractor shall utilize predictive modeling tools to stratify enrollees by risk and identify enrollees who are appropriate for case management. The predictive modeling tool shall consider physical, behavioral and SDOH needs which can be identified through claims, pharmacy, UM and other data, including laboratory results, and supplemented by referrals and HNA results, which may lead an enrollee to be categorized as rising or high risk.
Predictive Modeling. At the State’s request, the Contractor shall perform predictive modeling for disasters that can impact the state of Tennessee’s property insurance program and make recommendations based on that analysis to assist the State in determining the amount of excess property insurance to be procured. The analysis and recommendations shall be provided to the State by a date mutually agreed to in writing by the Parties.
