develop the projected costs. Disclosure of supporting data used in the calculations, including monthly paid claims and enrollment, claims analysis, trend analysis, demographic analysis, etc. Substantiation of any proposed increase in fixed costs via a thorough analysis of activities and costs covered by those fees. Explanations for any unusual trend results (high relative to the market, low relative to the market). Claims Standards 99% of dollars Measured by the 2.00% of fees if processed accurately. State's 99% but at Financial Accuracy independent least 97%. 4.00% Measures the auditor as part of of fees if less than gross dollars paid the annual claims 97%. incorrectly audit. Criteria as (overpayments defined by the plus State's underpayments) independent subtracted from auditor. Measured total paid claim to two (2) decimal dollars, divided by places. total paid claim dollars within the audit sample Claims Standards 97% of claims with Measured by the 2.00% of fees if benefit payments are independent below 97% but at Payment Accuracy processed accurately. auditor as part of least 95%. 4.00% Measures the the annual claims of fees if less than number of audit. Criteria as 95%. incorrect drafts of defined by the payments made State's on behalf of the independent State, subtracted auditor. Measured from the total to two (2) decimal draft or payment places.
develop the projected costs. Disclosure of supporting data used in the calculations, including monthly paid claims and enrollment, claims analysis, trend analysis, demographic analysis, etc. Substantiation of any proposed increase in fixed costs via a thorough analysis of activities and costs covered by those fees. Explanations for any unusual trend results (high relative to the market, low relative to the market). Claims Standards Financial Accuracy Measures the gross dollars paid incorrectly (overpayments plus underpayments) subtracted from total paid claim dollars, divided by total paid claim dollars within the audit sample 99% of dollars processed accurately. Measured by the State's independent auditor as part of the annual claims audit. Criteria as defined by the State's independent auditor. Measured to two (2) decimal places. 2.00% of fees if 99% but at least 97%. 4.00% of fees if less than 97%. Claims Standards Payment Accuracy Measures the number of incorrect drafts of payments made on behalf of the State, subtracted from the total draft or payment 97% of claims with benefit payments are processed accurately. Measured by the independent auditor as part of the annual claims audit. Criteria as defined by the State's independent auditor. Measured to two (2) decimal places. 2.00% of fees if below 97% but at least 95%. 4.00% of fees if less than 95%.
SLEOLAMedical_FA2_EPO-SF.docx