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Building Actuarial Cost Models From Health Care Claims Data
across the country generates billions of claim records annually. Claim records originate as a form of invoice ... Providers submit the claims to the liable payer (typically a health plan, government agency or the patient) ...- Authors: William Bednar
- Date: Jun 2017
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Strategic Insight and Integration>Influence decisions; Technical Skills & Analytical Problem Solving>Innovative solutions; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Health & Disability>Health insurance; Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence
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Modeling Anti-selective Lapse and Optimal Pricing in Individual and Small Group Health Insurance
Rather than being assumed at the outset, lapse rates emerge from the model, along with assessment spiral ... ratio projections. Under the model optimal pricing strategy depends on whether the class being rated has ...- Authors: D Wei
- Date: Feb 2010
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Incorporate risk management
- Publication Name: Health Watch
- Topics: Economics>Health economics; Health & Disability>Health risks; Modeling & Statistical Methods; Technology & Applications>Analytics and informatics
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Operational Considerations in Predictive Modeling
Operational Considerations in Predictive Modeling This article ... summarizes some of the operational considerations necessary to optimize the usefulness and impact of a predictive ...- Authors: Christine Hofbeck
- Date: May 2014
- Competency: Results-Oriented Solutions>Actionable recommendations; Results-Oriented Solutions>Assess decision effectiveness
- Publication Name: Health Watch
- Topics: Technology & Applications>Analytics and informatics; Technology & Applications>Business intelligence
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Medicare Advantage Hierarchical Condition Categories: Targeting Chart Reviews
codes to CMS will result in a higher risk score for the member and increased payments to Medicare Advantage ... Milliman's HCC prevalence study illustrates the significant variations in HCC prevalence rates by ...- Authors: Corey Berger, Eric P Goetsch
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving
- Publication Name: Health Watch
- Topics: Demography; Health & Disability>Health risks; Modeling & Statistical Methods>Data mining; Social Insurance>Medicare; Technology & Applications>Analytics and informatics
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Rethinking Family Tiers
who was covered. The question we were asked: simply, what is the average cost of a child? We requested ... requested data on the average claims of this employer’s children, but by a stroke of luck we received ...- Authors: Kristi Bohn
- Date: Jan 2011
- Competency: External Forces & Industry Knowledge>Actuarial methods in business operations; Results-Oriented Solutions>Actionable recommendations; Technical Skills & Analytical Problem Solving>Problem analysis and definition
- Publication Name: Health Watch
- Topics: Modeling & Statistical Methods>Data mining; Technology & Applications>Analytics and informatics