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10-K Medical Claims Payable (Tables)
 9 Months Ended 12 Months Ended
Sep. 30, 2023
Dec. 31, 2022
Liability for Claims and Claims Adjustment Expense [Abstract]    
Reconciliation Of The Beginning And Ending Balances For Medical Claims Payable
A reconciliation of the beginning and ending balances for medical claims payable for the nine months ended September 30, 2023 and 2022 is as follows:
20232022
Gross medical claims payable, beginning of period$15,348 $13,282 
Ceded medical claims payable, beginning of period(6)(21)
Net medical claims payable, beginning of period15,342 13,261 
Business combinations and purchase adjustments— 133 
Net incurred medical claims:
Current period91,058 84,177 
Prior periods redundancies(1,342)(901)
Total net incurred medical claims89,716 83,276 
Net payments attributable to:
Current period medical claims77,048 70,453 
Prior periods medical claims12,097 11,219 
Total net payments89,145 81,672 
Net medical claims payable, end of period15,913 14,998 
Ceded medical claims payable, end of period4 3 
Gross medical claims payable, end of period$15,917 $15,001 
A reconciliation of the beginning and ending balances for medical claims payable for the years ended December 31, 2022, 2021 and 2020 is as follows:
202220212020
Gross medical claims payable, beginning of year$13,282 $11,135 $8,647 
Ceded medical claims payable, beginning of year(21)(46)(33)
Net medical claims payable, beginning of year13,261 11,089 8,614 
Business combinations and purchase adjustments133 420 339 
Net incurred medical claims:
Current year113,414 100,440 85,094 
Prior years redundancies(869)(1,703)(637)
Total net incurred medical claims112,545 98,737 84,457 
Net payments attributable to:
Current year medical claims98,997 88,156 74,629 
Prior years medical claims11,600 8,829 7,692 
Total net payments110,597 96,985 82,321 
Net medical claims payable, end of year15,342 13,261 11,089 
Ceded medical claims payable, end of year6 21 46 
Gross medical claims payable, end of year$15,348 $13,282 $11,135 
Reconciliation of Net Incurred Medical Claims to Benefit Expense
The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for the periods in 2023 is as follows:
Three Months Ended Nine Months Ended September 30, 2023
March 31, 2023June 30, 2023September 30, 2023
Total net incurred medical claims$29,683 $30,495 $29,538 $89,716 
Quality improvement and other claims expense1,103 1,109 1,068 3,280 
Benefit expense$30,786 $31,604 $30,606 $92,996 
The reconciliation of net incurred medical claims to benefit expense included in our consolidated statements of income for the periods in 2022 is as follows:
Three Months Ended Nine Months Ended September 30, 2022
March 31, 2022June 30, 2022September 30, 2022
(Restated)(Restated)(Restated)(Restated)
Total net incurred medical claims$27,131 $27,634 $28,511 $83,276 
Quality improvement and other claims expense1,100 1,161 910 3,171 
Benefit expense$28,231 $28,795 $29,421 $86,447 
 The reconciliation of net incurred medical claims to benefit expense included in the consolidated statements of income is as follows:
Years Ended December 31
202220212020
Total net incurred medical claims$112,545 $98,737 $84,457 
Quality improvement and other claims expense4,097 3,834 3,588 
Benefit expense$116,642 $102,571 $88,045 
Short-Duration Insurance Contracts, Claims Development  
Incurred claims development, net of reinsurance, for the years ended December 31, 2022, 2021 and 2020 is as follows:
Cumulative Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
20202021
Claim Years(Unaudited)(Unaudited)2022
2020 & Prior$93,410 $91,708 $91,683 
2021100,860 100,016 
2022113,547 
Total$305,246 
Paid claims development, net of reinsurance, for the years ended December 31, 2022, 2021 and 2020 is as follows:
Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance
20202021
Claim Years(Unaudited)(Unaudited)2022
2020 & Prior$82,322 $91,151 $91,488 
202188,156 99,419 
202298,997 
Total$289,904 
At December 31, 2022, the total of incurred but not reported liabilities plus expected development on reported claims was $195, $597 and $14,550 for the claim years 2020 and prior, 2021 and 2022, respectively.
At December 31, 2022, the cumulative number of reported claims was 360, 440 and 404 for the claim years 2020 and prior, 2021 and 2022, respectively.
Reconciliation of Short Duration Medical Claims Payable to the Consolidated Medical Claims Payable
The reconciliation of the medical claims payable reflected in the tables above to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of September 30, 2023 and December 31, 2022, is as follows:
September 30, 2023December 31, 2022
Net medical claims payable, end of period$15,913 $15,342 
Ceded medical claims payable, end of period4 6 
Insurance lines other than short duration259 248 
Gross medical claims payable, end of period$16,176 $15,596 
The reconciliation of incurred and paid claims development information for the three years ended December 31, 2022, reflected in the tables above, to the consolidated ending balance for medical claims payable included in the consolidated balance sheet, as of December 31, 2022, is as follows:
Total
Cumulative incurred claims and allocated claim adjustment expenses, net of reinsurance$305,246 
Less: Cumulative paid claims and allocated claim adjustment expenses, net of reinsurance289,904 
Net medical claims payable, end of year15,342 
Ceded medical claims payable, end of year6 
Insurance lines other than short duration248 
Gross medical claims payable, end of year$15,596 
Schedule of Causes of Increase (Decrease) in Liability for Unpaid Claims and Claims Adjustment Expense  
The following table provides a summary of the two key assumptions having the most significant impact on our incurred but not paid liability estimates for the years ended December 31, 2022, 2021 and 2020, which are the completion and trend factors. These two key assumptions can be influenced by utilization levels, unit costs, mix of business, benefit plan designs, provider reimbursement levels, processing system conversions and changes, claim inventory levels, claim processing patterns, claim submission patterns and operational changes resulting from business combinations. We had increased estimation uncertainty on our incurred but not reported liability at December 31, 2022 and December 31, 2021. Slowdowns in claims submission patterns and increases in utilization levels for COVID-19 testing and treatment are the primary factors that lead to the increased estimation uncertainty.
 Favorable Developments
by Changes in Key Assumptions
 202220212020
Assumed trend factors$(859)$(1,429)$(599)
Assumed completion factors(10)(274)(38)
Total$(869)$(1,703)$(637)