Description: CPT, NCCI, ICD, CCI, DRG, APC, PTP – understanding healthcare claims involve a dizzying array of code sets and payment methodologies, and yet the claim form is the intersection of health plan affordability, provider payment, and data analysis. This webcast will cover: • The code sets used in medical coding • Types of correct coding policies implemented by CMS and commercial payers • Payment integrity strategies to drive health plan affordability • Data analytics approaches leveraging medical coding knowledge

Description: The purpose of this report is to start an informed debate on the issues surrounding the treatment of diversification in the solvency assessment of insurers. The members of the Chief Risk Officer Forum herein suggest a framework for how diversification should be treated within a prudential regulatory framework.

Description: Actuary Dave Dillon describes his role volunteering his time as a teacher in higher education, including the rewards and challenges that teaching offers. He discusses the importance of being attentive to his audience’s pre-existing knowledge and adapting his presentations accordingly. His work as a teacher typically encompasses three distinct domains: 1) acquainting young students with the actuarial profession, 2) educating non-actuaries about public policy issues related to health insurance (including the Affordable Care Act), and 3) instructing current actuaries on advanced methodologies and principles within the field. Recently he taught a health insurance course for actuarial science graduate students at Georgia State University and lectured at Boise State University’s master's program in Population & Health Systems Management. In every teaching and mentoring opportunity, actuaries can contribute to the expansion and prosperity of the profession and are encouraged to pursue these endeavors.

Description: The article provides an overview of the federal tax treatment of long-term care insurance contracts, including a brief history of the tax treatment of long-term care insurance, the requirements that must be satisfied in order to be treated as qualified long-term care insurance under the Internal Revenue Code, and a brief discussion of qualified long-term care combination products and chronic and terminal illness accelerated death benefits offered under life insurance contracts.

Description: The key tasks of credit risk capital project under CROSS II mainly focus onL(1 )Adjustment of measurement framework; (2) Calibration of risk factors, including both credit spread risk and credit default risk;3)Introduction of concentration risk measurement; (4) Higher requirement on look-through rule.

Description: An overview of bias and fairness in machine learning models, as they apply to use cases in life insurance.

Description: Review of non public options to finance care including personal savings, revers mortgages, family care and private insurance.

Description: Summary of the December 2003 NAIC Meeting

Description: This article reviews the topics discussed at the December 2004 meeting of the Life and Health Actuarial task force. The covered topics include Actuarial Guideline 38 and Reserves for Variable Annuities C-3 Phase 2 reserves.

Description: The presenters will cover the variation in risk adjustment approaches used across state Medicaid programs and compare them to other Federal programs. Additionally, recent developments, such as the use of OCR to extract data from medical charts for risk adjustment, will be discussed.