Statutes, codes, and regulations
Delaware Administrative Code
Title 16 - Health and SafetyDepartment of Health and Social ServicesDivision of Social ServicesDelaware Social Services Manual
Certification and Regulation of Medicaid Managed Care Organizations
Section 70000-9 - Reserved Funds For Incurred But Not Reported Costs And Received But Unpaid Claims

16 Del. Admin. Code § 70000-9

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Current through Register Vol. 28, No. 7, January 1, 2025
Section 70000-9 - Reserved Funds For Incurred But Not Reported Costs And Received But Unpaid Claims
9.1 The MMCO shall establish and maintain an actuarially sound process for estimating and tracking incurred but not reported costs and received but unpaid claims. The MMCO shall reserve funds for each major category of service (e.g., hospital inpatient, physician, nursing facility) to cover both incurred but not reported and reported but unpaid claims. The MMCO shall conduct reviews, at least annually, to assess its reserving methodology and make adjustments deemed by DHSS to be necessary to the methodology.

16 Del. Admin. Code § 70000-9

18 DE Reg. 693( 3/1/2015) (Final)