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{"sheet":"MA Req Rev","index":0,"n_rows":49,"n_cols":15,"rows_kept":49,"cut":false,"hidden":false,"merged":[[34,1,34,5],[2,3,2,7],[3,3,3,7],[4,3,4,7],[5,3,5,7],[0,1,0,12],[10,10,10,11],[10,12,10,13],[8,1,8,14],[10,3,10,6]],"flags":["formulas_cached_only"]}
[null,"Attachment III: Medicare Advantage Medical Utilization and Expenditure Experience"]
[]
[null,"Contract number"]
[null,"PBP"]
[null,"Organization Name"]
[null,"Reporting period"]
[]
[null,null,"(1)","(2)","(3)","(4)","(5)","(6)","(7)","(8)","(9)","(10)","(11)","(12)","(13)"]
[null,"Medical Expenses"]
[]
[null,null,null,"Utilization",null,null,null,"Plan Experience",null,null,"Allowed cost",null,"Cost sharing",null,"Net"]
[{"$nulls":7},"Total","Total Member","Allowed","Total","Supplemental","Medicare","Supplemental","supplemental"]
[null,null,null,"Member Months","Utilizers","Utilization","Total","Plan","cost","cost","Medicare","benefits","actuarial","benefits","benefits"]
[null,null,"       Service Category","Months Cov.",null,"Type","Utilization","reimb.","sharing","(g + h)","covered","(i - j)","equivalent","(l - h)","(k + m)"]
[]
[null,"a.","Inpatient Facility",{"$nulls":6},0,null,0,null,0,0]
[null,"b.","Skilled Nursing Facility",{"$nulls":6},0,null,0,null,0,0]
[null,"c.","Home Health",{"$nulls":6},0,null,0,null,0,0]
[null,"d.","Ambulance",{"$nulls":6},0,null,0,null,0,0]
[null,"e.","DME/Prosthetics/Supplies",{"$nulls":6},0,null,0,null,0,0]
[null,"f.","OP Facility - Emergency",{"$nulls":6},0,null,0,null,0,0]
[null,"g.","OP Facility - Surgery",{"$nulls":6},0,null,0,null,0,0]
[null,"h.","OP Facility - Other",{"$nulls":6},0,null,0,null,0,0]
[null,"i.","Professional",{"$nulls":6},0,null,0,null,0,0]
[null,"j.","Part B Rx",{"$nulls":6},0,null,0,null,0,0]
[null,"k.","Other Medicare Part B",{"$nulls":6},0,null,0,null,0,0]
[null,"l.","Transportation (Non-Covered)",{"$nulls":6},0,0,0,0,0,0]
[null,"m.","Dental (Non-Covered)",{"$nulls":6},0,0,0,0,0,0]
[null,"n.","Vision (Non-Covered)",{"$nulls":6},0,0,0,0,0,0]
[null,"o.","Hearing (Non-Covered)",{"$nulls":6},0,0,0,0,0,0]
[null,"p.","Health & Education (Non-Covd)",{"$nulls":6},0,0,0,0,0,0]
[null,"q.","Other Non-Covered",{"$nulls":6},0,0,0,0,0,0]
[null,"r.","Total Medical Expenses",{"$nulls":6},0,null,0,null,0,0]
[]
[null,"Supplemental data"]
[null,"Total Enrollees"]
[null,"Member months"]
[null,"Premiums collected"]
[null,"CMS revenue collected"]
[null,"Reserve for outstanding claims"]
[]
[null,"Notes"]
[null,"1. Form to be completed at the plan level."]
[null,"2. Data to be entered by Plans are shaded in blue.  "]
[null,"3. Data calculated by CMS are shaded in yellow."]
[null,"4. Utilization types: A - Admits; D - Days; BP - Benefit period; V - visits; P - procedures; T - Trips; S - Scripts; O - other; U - Data is unavailable"]
[null,"5. Medicare actuarial equivalent cost sharing to be developed using actuarial equivalent factors contained in MA bid pricing tool.  "]
[null,"6. Premiums collected include payments from plan enrollees, employer/union groups, State Medicaid agencies, and other third parties."]
[null,"7. Optional supplemental benefits, revenues, and member months are to be excluded."]

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["Reporting Period"]
[2006]
[2007]
[]
[]
["Utilization Types"]
["A - Admits"]
["D - Days"]
["BP - Benefit period"]
["V - Visits"]
["P - Procedures"]
["T - Trips"]
["S - Scripts"]
["O - Other"]
["U - Unavailable"]