Description: Discussion of Medicare's Ambulatory Payment Classification APC system as the standard for reimbursement of non-capitated outpatient hospital services with sample calculations. Issue No. 37.

Description: When setting reserves, multiple methods are often used in the creation of the reserve estimate. Judgment is warranted to combine these different estimates into a final recommendation. This paper describes two techniques that can be used to combine these estimates that may result in better accuracy and lower variance.

Description: Discussion of methods to estimate unpaid claim liability UCL for health plans. Includes traditional IBNR lag method and a lag method based on claims reported but not paid RBNP. Issue No. 45

Description: Adjusting the 1985 NAIC Cancer Claim Cost Tables, a collection of morbidity tables, for Inflation and benefit changes Issue No. 34.

Description: With many pharmacy benefit plans now considering whether to add a 4th tier for high priced specialty drugs, review and discussion also needs to be given to the other end of the pharmacy cost spectrum to see how costs can be reduced by promoting lower cost over-the counter OTC drugs. From Health Watch News, September 2006, Issue No. 53.

Description: Uses Monte Carol simulation to discuss increase in aggregate stop loss claim frequencies due to changes in selling strategies, August 2000, Issue No. 38.