HHS CMS Awards Prime Contract to SCG for Statistical Modeling and Coding AnalysisHHS Centers for Medicare & Medicaid Services Awards Prime Contract to Signature Consulting Group for the Statistical Modeling and Coding Analysis on the Health Insurance Marketplace
The Centers for Medicare & Medicaid Services´ Center for Consumer Information and Insurance Oversight and Centers for Medicare divisions awarded a prime contract to Maryland-based Signature Consulting Group (SCG) to provide statistical modeling and coding analysis on issues related to payments, including risk adjustment systems and auditing financial processes from the Patient Protection and Affordable Care Act (ACA) Health Insurance Marketplace. SCG will validate and work to mitigate the most substantial financial and payment risks with respect to ACA, including risk adjustment modeling, transfer and payment errors.
The ACA was passed in 2010 with a goal of decreasing health insurance costs and increasing insurance coverage to ultimately expand diversification in the non-elderly population. Another aim of the ACA is to effectively force diversification in the provision of health care services (e.g., individual mandate and no pre-existing condition bar.) Risk-related elements addressed by the ACA include risk corridors, reinsurance and risk adjustment. The Health Insurance Marketplace is a set of government regulated and standardized health plans where individuals eligible for federal subsidies may purchase health insurance.
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