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

  • Credibility adjustment The base experience data was developed based on blending calendar year 2014 cost report and encounter data at the rate cell level using a 90% (cost report) / 10% (encounter) weighting.

  • 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.

  • While this discussion draft specifically asks about how SPS can be managed within drug development, the corollary Algorithm Change Protocol (ACP) – which details how changes in the SPS will be performed and validated – provides an equally important guide to navigating evolving algorithms in drug development.

  • 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.

  • 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)).

  • 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.

  • Credibility adjustment The base experience data was primarily developed based on blending CY 2015 cost report and encounter data at the rate cell level using a 75% (cost report) / 25% (encounter) weighting.


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

  • Equity Adjustment means the dollar amount resulting by subtracting the Book Value, as of Bank Closing, of all Liabilities Assumed under this Agreement by the Assuming Bank from the purchase price, as determined in accordance with this Agreement, as of Bank Closing, of all Assets acquired under this Agreement by the Assuming Bank, which may be a positive or a negative number.

  • 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;

  • True-Up Adjustment means any Annual True-Up Adjustment or Interim True-Up Adjustment, as the case may be.

  • Social Maladjustment means a consistent inability to conform to the standards for behavior established by the school. Such behavior is seriously disruptive to the education of the student or other students and is not due to emotional disturbance as defined in (c) 5 above.

  • XXXXX Adjustment means, with respect to XXXXX, 0.0326% per annum.

  • Cost of Living Adjustment or “COLA” means a percentage-based general wage increase adjustment provided in accordance with this memorandum of agreement. COLA is an upward adjustment applied to and folded into all wage rates. The "annualized average of BC CPI over twelve months” (AABC CPI) means the Latest 12-month Average Index % Change reported by BC Stats in March for British Columbia for the twelve months starting at the beginning of March in the preceding year and concluding at the end of the following February. The “Latest 12-month Average Index”, as defined by BC Stats, is a 12-month moving average of the BC consumer price indexes of the most recent 12 months. This figure is calculated by averaging index levels over the applicable 12 months. The Latest 12-month Average Index % Change is reported publicly by BC Stats in the monthly BC Stats Consumer Price Index Highlights report. The BC Stats Consumer Price Index Highlights report released in mid-March will contain the applicable figure for the 12 months concluding at the end of February. The percentage change reported by BC Stats that will form the basis for determining any COLA increase is calculated to one decimal point. For reference purposes only, the annualized average of BC CPI over 12 months from March 1, 2021 to February 28, 2022 was 3.4%.

  • Tax Adjustment has the meaning set forth in Section 4.7.

  • Market Value Adjustment means, on a given date, an amount equal to the lesser of (x) 98% and (y) a percentage determined according to the following formula: Market Value Adjustment = 98% – [(10yrCMTt – 10yrCMTlaunch) ×Duration], where 10yrCMTt = the 10-Year Treasury Constant Maturity Rate published each business day by the Board of Governors of the Federal Reserve System, or, if such rate ceases to be published, a successor rate reasonably determined by the Trustees (the “10-Year CMT”), on such repurchase date; 10yrCMTlaunch = the 10-Year CMT as of the end of the Initial Offering Period; and Duration = an estimate of the duration of the periodic interest payments of a hypothetical coupon-paying U.S. Government Security with a 25-year maturity, calculated by the Trust’s Investment Manager as of the end of the Initial Offering Period;

  • CPI Adjustment means the quotient of (i) the CPI for the month of January in the calendar year for which the CPI Adjustment is being determined, divided by (ii) the CPI for January of 2007.

  • 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.

  • Final Adjustment has the meaning set forth in Section 10.3.B(2) hereof.

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

  • Estimated Adjustment Amount has the meaning set forth in Section 2.5(a).

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

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

  • Estimated Working Capital Adjustment means the amount by which the Estimated Working Capital is greater or less than the Base Working Capital, any such excess amount being treated as a positive number and any shortfall being treated as a negative number;

  • 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:

  • Value Adjustments means cash lending revenues and other revenues on collateral in respect of a Series of ETP Securities.

  • 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:

  • SNB Adjustment Spread means, with respect to the SNB Policy Rate, the spread to be applied to the SNB Policy Rate in order to reduce or eliminate, to the extent reasonably practicable under the circumstances, any economic prejudice or benefit (as applicable) to Noteholders as a result of the replacement of the Swiss Average Rate Overnight with the SNB Policy Rate for purposes of determining SARON, which spread will be determined by the Calculation Agent, acting in good faith and a commercially reasonable manner, taking into account the historical median between the Swiss Average Rate Overnight and the SNB Policy Rate during the two year period ending on the date on which the SARON Index Cessation Event occurred (or, if more than one SARON Index Cessation Event has occurred, the date on which the first of such events occurred).

  • Working Capital Adjustment has the meaning set forth in Section 2.5(a).

  • Increased Assessed Value means, for each Fiscal Year during the term of this Agreement, the amount by which the Current Assessed Value for such year exceeds the Original Assessed Value. If the Current Assessed Value is less than or equal to the Original Assessed Value in any given Tax Year, there is no Increased Assessed Value in that year.

  • 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.

  • Price Adjustment means any and all price reductions, offsets, discounts, rebates, adjustments, and or refunds which accrue to or are factored into the final net cost to the hospital outpatient department or ambulatory surgical center.