Credibility Adjustment definition
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.
Credibility Adjustment means the adjustment to account for random statistical fluctuations in claims experience for smaller plans.
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.
Examples of Credibility Adjustment in a sentence
The Contractor may not add a Credibility Adjustment to a calculated MLR if the MLR Reporting Year experience is fully credible.
In addition, Newmont shall have the right, upon reasonable notice to Grantor, to inspect and copy all books, records, technical data, information and materials (the "Data") pertaining to Grantor's activities with respect to the Property; provided that such inspections shall not unreasonably interfere with Grantor's activities with respect to the Property.
The Credibility Adjustment is added to the reported MLR calculation before calculating any remittance due.
More Definitions of Credibility Adjustment
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.
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.
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.