Question

BCBS Hospital Expenses: Column A: calculate the Average amount of Member Months 2020 in Column A for January through July? Column B : calculate the Average Amount of Paid Expenses in Column B for January through April 2020 ? (3-month lag for hospital expenses) Column C: calculate Hospital Expenses Paid per Month per Member for January through July 2020 ? (Formula: Paid Expenses/Member Months) Column F: Calculate Completion % based on Dollar Amounts for Paid Claims and Projected Expenses which were calculated by the Actuary (B/G) Column H: Calculate Projected Expenses per month per member (Projected Expenses/Member Months) A B C=B/A D=G-B Incrurred but not received claims E=D/G F = B/G MONTHLY G H = G/A | INCURRED MEMBER MONTHS PAID EXPENSES PAID PMPM IBNR EXPENSES IBNR % Completion % PROJECTED EXPENSES PROJ PMPM EXPENSES 202001 202002 1.3% 1.4% 2.1% 202003 202004 36,153 36,015 35,850 35,010 34,531 34,090 32.374 2,835,320 2,783,140 2,329,846 2,517,479 1,718,826 2,237,499 431,975 0 38,449 40,824 49,032 102,145 292,667 709,999 2,292,767 3.9% 2,873,770 2,823,964 2,378,878 2,619,623 2,011,493 2,947,498 2,724,742 0 14.5% 24.1% 202005 202006 202007 202008 202009 0 0 84.1% 0.0% 0.0% 0.00 0.00 0 0 0 0 0.00% 0.00% 0.00% 0.00% 0 0 0 0 0.00 0.00 0 0 0 0 202010 202011 202012 TOTALS 0.0% 0.0% 0.0% 19.2% 0 0 14,854,085 0 3,525,882 0.00% 80.82% 0 18,379,967 0.00 75.32 244,023 60.87

Answer 1

DI Pg i elta Column A :- 2 Average Amount a Total of 앙 memba month No. of months = 36153 + 36015 + 358 50+ 3 5010+ 34531+ 34090 6. 211649 6 35,274.8 35975 in because this the will month of Jully statement January January through July not take 1st th anuay tiul june. Column B :- Average amt of paid expenses Total of expense of 3 months of months 2835320 + 2783140 + 2329846 3 7948 306 3 2649415:3 2649435

72 elta Column C :- Expenses paid Paid Expenses member months 2835380 + 278 3140t 23 28846+a517478+ 1718 826 +2237499 + 431975 36153 + 360lst 3 58sot 3 solot 345314 34090+ 32374 = 14854085 -431975 244023 32374 - 14422110 211648 68.14 I per member / per month Column H :- Projeded Expense permonth bee member = Projected Expenses Member Months 18379967 244023 75.19 2 75.2 l pa month month per member