Description: The American Academy of Actuaries task force charged with developing a risk-base capital formula for health insurers submitted its preliminary report to the NAIC Health Organizations Risk-Based Capital Working Group.

Description: Pricing small group medical coverage under reform laws using debit manual and risk factors. Issue No. 45.

Description: Many executives are talking about predictive analytics uses in health insurance.

Description: This article compares three potential approaches to determining new coefficients for health-based risk scoring models: full recalibration, p-value credibility weighting, and penalized ridge regression.

Description: This article examines two general approaches to pricing The Forecast Approach and the Rebuilding Approach. The author then supplies the reader with the best approach. From Health Watch Newsletter, March 2005, Issue No. 49.

Description: The process of setting initial and renewal premium rates for small group medical block of business using risk characteristics. Presents three pricing schemes and compares profitability Following the Curve, Lowest Best Rate and Highest Worst Rate.

Description: This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for fraud detection in Medicare.

Description: This paper will develop an aggregate claim reserve methodology for health claims. The theoretical nature of the unpaid claim process is outlined and discussed. This is then used to develop a paradigm shift, which views the claim reserve estimation as a projection of claims from one period to another, rather than as a matter of estimating residual unpaid claims from observed paid claims.