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Validating a Novel Health Insurance Fraud Detection Method
Validating a Novel Health Insurance Fraud Detection Method This article describes methodologies for detection and deterrence of Medicare fraud. It also describes the validation of PRIDIT for ...- Authors: Robert D Lieberthal, Elias
- Date: Aug 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Strategic Insight and Integration>Effective decision-making; Technical Skills & Analytical Problem Solving>Incorporate risk management; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Risk Management
- Topics: Economics>Health economics; Enterprise Risk Management; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Public financing - Health & Disability; Modeling & Statistical Methods>Data mining; Predictive Analytics
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Implementing Parity: Investing in Behavioral Health – Part 2
Implementing Parity: Investing in Behavioral Health – Part 2 Part 1 of a 2-part series exploring implementation issues for the Mental Health Parity and Addiction Equity Act of 2008 MHPAEA. Part ...- Authors: Stephen P Melek
- Date: Sep 2010
- Competency: External Forces & Industry Knowledge; Strategic Insight and Integration>Effective decision-making
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Public Policy
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Health Watch, February 2018, Issue 85
Health Watch, February 2018, Issue 85 Read the February 2018 issue of Health Watch, published by the Health Section. Practical information for actuaries, articles impact sections, section ...- Authors: Society of Actuaries
- Date: Feb 2018
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Health Reform - A Proposal
Health Reform - A Proposal Essay reforming healthcare where participants have a vested interest in reaching the best answer. Cancer;Diabetes;Employee contributions;Employer contributions;Health ...- Authors: Timothy Luedtke
- Date: Jun 2009
- Competency: Communication>Persuasive communication; Communication>Written communication; External Forces & Industry Knowledge; Leadership>Influence; Leadership>Thought leadership; Professional Values>Public interest representation; Strategic Insight and Integration
- Topics: Enterprise Risk Management>Compliance; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Life Insurance; Life Insurance>Underwriting - Life Insurance; Life Insurance>Whole life; Long-term Care>Medical expenses; Pensions & Retirement>Funding; Social Insurance>Medicaid; Social Insurance>Medicare; Social Insurance>Social Security; Health & Disability>Electronic medical record
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The ACA’s Medical Loss Ratio Provisions: Looking Back
The ACA’s Medical Loss Ratio Provisions: Looking Back The ACA’s Medical Loss Ratio Provisions Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health ...- Authors: Rowen Bell
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Prologue
Prologue Introduction to the ACA @ 5 publication Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health insurance;Medical Loss Ratio=MLR;Accountable care ...- Authors: Jim Toole
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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Abstracts of Health Articles from the North American Actuarial Journal
Abstracts of Health Articles from the North American Actuarial Journal Highlights of health related articles from the North American Actuarial Journal. A paper on health care reform and ...- Authors: Ian G Duncan
- Date: Jan 2015
- Competency: External Forces & Industry Knowledge>Actuarial theory in business context
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Payment models; Public Policy
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Integrating Claims-Based and Survey-Based Data to Estimate Program Savings
Integrating Claims-Based and Survey-Based Data to Estimate Program Savings An approach to quantify medical intervention savings when medical claims data is not available by leveraging overlapping ...- Authors: Andrew Mackenzie, Ian G Duncan
- Date: Oct 2017
- Competency: Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Process and technique refinement
- Publication Name: Health Watch
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Modeling & Statistical Methods>Estimation methods; Modeling & Statistical Methods>Regression analysis
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The CLASS Act and its Aftermath
The CLASS Act and its Aftermath CLASS Act and ACA Patient Protection and Affordable Care Act= PPACA=Affordable Care Act;Health care reform;Health insurance;Medical Loss Ratio=MLR;Accountable care ...- Authors: Robert Yee
- Date: Aug 2015
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; External Forces & Industry Knowledge>Actuarial theory in business context; External Forces & Industry Knowledge>External forces and business performance
- Topics: Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health information technology; Health & Disability>Health insurance; Health & Disability>Health risks; Health & Disability>Payment models; Health & Disability>Public financing - Health & Disability
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U.S. Health Care - Where to Look for Reform
U.S. Health Care - Where to Look for Reform Essay discussing cost, quality and access of healthcare and then describes the need for rationing. Bankruptcy;Health care costs;Health care quality; ...- Authors: Sam Gutterman
- Date: Jun 2009
- Competency: External Forces & Industry Knowledge
- Topics: Economics; Health & Disability>Health care; Health & Disability>Health care quality; Health & Disability>Health insurance; Social Insurance>Medicaid; Social Insurance>Medicare