Credibility adjustment definition

Credibility adjustment means the adjustment to account for random statistical fluctuations in claims experience for smaller plans.
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Credibility adjustment means an adjustment to the MLR for a partially credible CCO to account for a difference between the actual and target MLRs that may be due to random statistical variation.
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Credibility adjustment means an adjustment to the MLR for a partially credible PAHP to account for a difference between the actual and target MLRs that may be due to random statistical variation.
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Examples of Credibility adjustment in a sentence

  • Issuers with non- credible or fully credible experience do not have a deductible factor and can enter a value of 1.0. Line 3.5 – Credibility adjustment Lines 3.2 x 3.4 (DO NOT ROUND) Issuers with non-credible or fully credible experience do not receive a credibility adjustment and should enter zero.

  • Issuers with non- credible or fully credible experience do not have a deductible factor and can enter a value of 1.0. Line 3.5 – Credibility adjustment Enter the result of the following calculation: Lines 3.2 x 3.4 (DO NOT ROUND) Issuers with non-credible or fully credible experience do not receive a credibility adjustment and should enter zero.

  • Do not round.Line 4.2 – Credibility adjustment Enter the value from:Line 3.5, Total Column.Line 4.3 – MLR including credibility adjustment (if applicable) Enter the result of the following calculation:Lines 4.1a or 4.1b + 4.2, Total Column.

  • Line 3.5 – Credibility adjustment (MLR Form, Part 5, Lines 3.2 x 3.4) This amount is automatically calculated on the MLR Form based upon the amounts reported on Lines 3.2 and 3.4. Issuers with non-credible or fully credible experience do not receive a credibility adjustment.

  • Expenses that relate solely to the operation of a reporting entity, such as personnel costs associated with the adjusting and paying of claims, must be borne solely by the reporting entity and are not to be apportioned to the other entities.(h) Credibility adjustment.

  • Line 4.2 – Credibility adjustment Line 3.5, Total Column.Line 4.3 – MLR including credibility adjustment (if applicable) Lines 4.1a or 4.1b + 4.2, Total Column.

  • Issuers with non- credible or fully credible experience do not have a deductible factor and can enter a value of 1.0. Line 4.5 – Credibility adjustment Lines 4.2 x 4.4 (DO NOT ROUND) Issuers with non-credible or fully credible experience do not receive a credibility adjustment and should enter zero.

  • Line 4 – Medical Loss Ratio (MLR) Calculation Line 4.1 – Unadjusted MLRCalculated field: Worksheet 2 Line 1.3 divided by Worksheet 2 Line 2.3. Line 4.2 – Credibility adjustment Calculated field: Worksheet 2 Line 3.3 (multiplied by Line 3.4, if applicable)).

  • Credibility adjustment The MI Health Link eligible populations, in aggregate, were considered fully credible.

  • If Qwest desires to implement this change, then it should notify13 the Commission in Phase III of the Cost Docket, but must obtain14 Commission approval of such a change prior to its implementation.


More Definitions of Credibility adjustment

Credibility adjustment. As defined in 42 C.F.R. § 438.8, an adjustment to the Medical Loss Ratio (MLR) for a partially credible MCO to account for a difference between the actual and target MLRs that may be due to random statistical variation.
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Credibility adjustment means an adjustment to the medical loss ratio (MLR) for a partially credible CE or DBM to account for a difference between the actual and target MLRs that may be due to random statistical variation.
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Credibility adjustment. As defined in 42 CFR § 438.8, an adjustment to the Medical Loss Ratio (MLR) for a partially credible MCO to account for a difference between the actual and target MLRs that may be due to random statistical variation. “Crisis Support Services” Services designed for individuals experiencing circumstances such as (i) marked reduction in psychiatric, adaptive, or behavioral functioning; (ii) an increase in emotional distress; (iii) needing continuous intervention to maintain stability; or (iv) causing harm to themselves or others. Crisis support service means intensive supports by trained and, where applicable, licensed staff in crisis prevention, crisis intervention, and crisis stabilization for an individual who is experiencing an episodic behavioral or psychiatric event in the community that has the potential to jeopardize the current community living situation. This service is designed to prevent the individual from experiencing an episodic crisis that has the potential to jeopardize his current community living situation, to intervene in such a crisis, or to stabilize the individual after the crisis. This service shall prevent escalation of a crisis, maintain safety, stabilize the individual, and strengthen the current living situation so that the individual can be supported in the community beyond the crisis period.
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Related to Credibility adjustment

  • Informal adjustment means an agreement reached among the parties, with consultation, but not the consent, of the victim of the crime or other persons specified in KRS 610.070 if the victim chooses not to or is unable to participate, after a petition has been filed, which is approved by the court, that the best interest of the child would be served without formal adjudication and disposition;

  • Cost of Living Adjustment means the percentage (if any) by which the Consumer Price Index for the month of October preceding the adjustment ex- ceeds the Consumer Price Index for the month of October one year before the month of October preceding date of the adjustment.

  • Contract Term Adjustment means adjustment only as provided for in the three circumstances described in this Subsection. Under these circumstances, the contract term shall be adjusted in writing to include additional calendar days in one or more Normal Operating Seasons equal to the actual time lost, except as limited by paragraph (b) in this Subsection. To qualify for such adjustment, Purchaser shall give written notice of the lost time not later than 30 days after end of Normal Operating Season in which time was lost and at least 10 days before Termination Date. Contracting Officer shall make prompt written acknowledgment of such notice, indicating concurrence with the number of days in the notice or the number of days Forest Service considers as qualifying for the adjustment. Lost portions of days shall be disregarded in computing time lost. The three circumstances qualifying for a Contract Term Adjustment are:

  • Bid with Lowest Evaluated Cost means the bid quoting lowest cost amongst all those bids evaluated to be substantially responsive;

  • Final Adjustment Amount has the meaning set forth in Section 2.4(c).

  • SOFR Adjustment means 0.10% (10 basis points).

  • Benchmark Replacement Adjustment means, with respect to any replacement of the then-current Benchmark with an Unadjusted Benchmark Replacement for any applicable Interest Period and Available Tenor for any setting of such Unadjusted Benchmark Replacement:

  • Material Project EBITDA Adjustments means, with respect to each Material Project:

  • Peer review means evaluation of professional services rendered by a professional practitioner.

  • Related Adjustment means, in determining any LIBOR Successor Rate, the first relevant available alternative set forth in the order below that can be determined by the Administrative Agent applicable to such LIBOR Successor Rate:

  • Working Capital Adjustment shall have the meaning set forth in Section 3.5(c)(i).

  • Net Working Capital Adjustment means (a) the amount by which Net Working Capital as of immediately prior to the Closing exceeds Target Net Working Capital or (b) the amount by which Net Working Capital as of immediately prior to the Closing is less than Target Net Working Capital, in each case, if applicable; provided, that any amount which is calculated pursuant to clause (b) above shall be deemed to be a negative number.

  • Reduced leave schedule means a leave schedule that reduces the usual number of hours per workweek, or hours per workday, of an employee.

  • ISDA Fallback Adjustment means the spread adjustment (which may be a positive or negative value or zero) that would apply for derivatives transactions referencing the ISDA Definitions to be determined upon the occurrence of an index cessation event with respect to the Benchmark for the applicable tenor.