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A health insurer is analyzing claim payment patterns and needs to compare what providers billed against what the plan actually paid after contractual discounts. Which claims data field captures the negotiated rate after PPO discounts but before member cost-sharing?

Billed charges

Allowed amount

Paid amount

Member responsibility

to track

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2026 Statistics

Key Facts: GH 301 Exam

~5 hrs

Exam Time

SOA syllabus

~$1,275

Exam Fee

SOA fee table

20%

Predictive Modeling Weight

GH 301 syllabus

Sittings per Year

SOA exam schedule

$2,000

Part D OOP Cap (2025)

Inflation Reduction Act

Weighted Domains

GH 301 syllabus

GH 301 is a roughly 5-hour written-response case study exam offered three times per year (March, July, November). The 2026 syllabus weights Predictive Modeling for Health at 20%, with Health Data and Analytics, Care Management and UM, Quality Measures, and Population Health and Value-Based Care each at 15%, Pharmacy Analytics at 10%, and Health Equity/SDoH and ASOPs/Ethics at 5% each. SOA sets pass marks per sitting; the exam fee is approximately $1,275 and ASA plus GH 101 background is recommended.

Sample GH 301 Practice Questions

Try these sample questions to test your GH 301 exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A health insurer is analyzing claim payment patterns and needs to compare what providers billed against what the plan actually paid after contractual discounts. Which claims data field captures the negotiated rate after PPO discounts but before member cost-sharing?

A.Billed charges

B.Allowed amount

C.Paid amount

D.Member responsibility

Explanation: The allowed amount is the contractually negotiated rate the plan and provider have agreed to, after PPO discounts but before splitting between plan-paid and member cost-sharing. Paid amount equals allowed minus member responsibility (deductible, coinsurance, copay).

2A health actuary is reconciling year-end claim costs and needs to estimate the liability for medical services that have been rendered but not yet processed. Which claims concept best describes this?

A.Paid claims

B.Incurred but not reported (IBNR)

C.Allowed claims

D.Capitated payments

Explanation: IBNR represents claims for services already provided to members but not yet received or processed by the plan. ASOP 5 requires explicit IBNR estimation for health plan liabilities. Paid claims include only what has cleared the system.

3Which standard is used for the electronic exchange of clinical data between EHR systems and health information exchanges?

A.X12 837

B.HL7 FHIR

C.NCPDP D.0

D.ICD-10-CM

Explanation: HL7 FHIR (Fast Healthcare Interoperability Resources) is the modern HL7 standard for exchanging clinical data between EHRs and HIEs using RESTful APIs. X12 837 is for claim transactions; NCPDP D.0 is for pharmacy; ICD-10-CM is a diagnosis classification.

4A care management team wants to identify members with food insecurity and unstable housing. Which ICD-10-CM code family captures Social Determinants of Health?

A.E codes (endocrine)

B.Z55-Z65 (SDoH Z codes)

C.V codes (external causes)

D.F codes (mental health)

Explanation: ICD-10-CM Z codes Z55-Z65 capture SDoH such as housing instability (Z59), food insecurity (Z59.41), and education problems (Z55). CMS expanded SDoH Z code use through guidance encouraging documentation in 2023-2024 to support equity reporting.

5Which code set is used to report physician professional services and is maintained by the American Medical Association?

A.ICD-10-PCS

B.HCPCS Level II

C.CPT-4

D.DRG

Explanation: CPT-4 (Current Procedural Terminology, 4th edition) is a 5-digit code set maintained by the AMA for reporting physician professional services and outpatient procedures. ICD-10-PCS is for inpatient hospital procedures; HCPCS II covers drugs, devices, and supplies.

6An analyst sees code J7613 (albuterol, inhalation solution) on a claim. Which code set does this come from?

A.CPT-4

B.HCPCS Level II

C.ICD-10-CM

D.NDC

Explanation: J-codes are part of HCPCS Level II and are used to bill for drugs administered other than oral, including injectables and inhalation solutions. CPT-4 codes are 5 digits without an alpha prefix. NDCs are 11-digit drug identifiers used in pharmacy benefits.

7Approximately how many diagnosis codes does ICD-10-CM contain compared with the legacy ICD-9-CM?

A.About 14,000 codes, similar to ICD-9-CM

B.About 70,000 codes, roughly five times as many as ICD-9-CM

C.About 200,000 codes, over ten times as many as ICD-9-CM

D.About 4,000 codes, fewer than ICD-9-CM

Explanation: ICD-10-CM has roughly 70,000 diagnosis codes, compared with about 14,000 in ICD-9-CM, allowing far more clinical specificity (laterality, episode of care, etiology). ICD-10-PCS adds about 87,000 inpatient procedure codes separately.

8An inpatient claim shows MS-DRG 470 for a major joint replacement. Which payment system uses MS-DRGs as the basis for hospital reimbursement?

A.Outpatient Prospective Payment System (OPPS)

B.Medicare Inpatient Prospective Payment System (IPPS)

C.Medicare Physician Fee Schedule

D.Resource-Based Relative Value Scale

Explanation: MS-DRGs (Medicare Severity Diagnosis Related Groups) are the bundling categories used by the Medicare IPPS to pay hospitals a fixed rate per inpatient stay. OPPS uses APCs; the physician fee schedule uses RVUs.

9When linking pharmacy claims to medical claims for a chronic disease cohort, which identifier is most useful for identifying the specific drug strength and package size?

A.GPI (Generic Product Identifier)

B.NDC (National Drug Code)

C.ATC (Anatomical Therapeutic Chemical)

D.RxNorm RXCUI

Explanation: The NDC is an 11-digit code identifying a specific manufacturer, product strength, dosage form, and package size and appears on every dispensed pharmacy claim. GPI groups by therapeutic class; RxNorm provides normalized clinical names; ATC is a WHO classification by anatomical site.

10A claims data warehouse stores Place of Service (POS) codes. Which POS code typically indicates an outpatient hospital setting?

A.11

B.21

C.22

D.31

Explanation: POS code 22 indicates Outpatient Hospital. POS 11 is Office, POS 21 is Inpatient Hospital, and POS 31 is Skilled Nursing Facility. POS codes are critical for site-of-service analytics and value-based care reporting.

About the GH 301 Exam

SOA GH 301 Health Analytics and Management is the third specialty exam in the Group and Health (GH) FSA track, testing how candidates apply claims data, predictive modeling, care management, quality programs, value-based care, pharmacy analytics, and ASOPs to live employer and Medicare Advantage decisions.

Assessment

Written-response case study exam covering health data, risk adjustment, care management, quality, value-based care, pharmacy, equity, and ASOPs.

Time Limit

~5 hours

Passing Score

Pass mark set by SOA

Exam Fee

~$1,275 (Society of Actuaries (SOA))

GH 301 Exam Content Outline

15%

Health Data and Analytics

Claims data structure (paid vs incurred, allowed amount, place of service, revenue codes), EHR and HL7 FHIR exchange, ICD-10/CPT/HCPCS coding, MS-DRGs, and SDoH Z codes.

20%

Predictive Modeling for Health

Risk adjustment with HCC, CRG, and DCG; CMS-HCC V28 phase-in; HHS-HCC for ACA; GLM with offsets; Tweedie cost models; gradient boosting for utilization prediction; and model evaluation.

15%

Care Management and Utilization Management

Disease management, complex case management, prior authorization (including the 2024 CMS interoperability and PA rule), concurrent and retrospective review, and program evaluation including BCAs.

15%

Quality Measures

HEDIS measures and ECDS reporting, NCQA accreditation, Medicare Advantage and Part D Star Ratings (Tukey cut points and Health Equity Index), CMS Care Compare, MIPS, and MACRA.

15%

Population Health and Value-Based Care

MSSP ACOs and BASIC vs ENHANCED tracks, ACO REACH (replacing GPDC in 2023), BPCI Advanced, EOM (replacing OCM in 2023), Primary Care First, MCP, AHEAD, and full vs professional capitation.

10%

Pharmacy Analytics

PBM operations, formulary tiers, prior authorization and step therapy, specialty drug pipeline, Humira biosimilar wave (2023+), GLP-1 spend trends, IRA $35 insulin cap, and the 2025 Part D $2,000 OOP cap.

Health Equity and SDoH

REL data collection (including BISG imputation), SDoH screening (PRAPARE, AHC HRSN), algorithmic bias (Obermeyer 2019), and the Stars Health Equity Index reward beginning 2027.

ASOPs and Ethics

ASOP 5 health plan liabilities, ASOP 12 risk classification, ASOP 23 data quality, ASOP 38 catastrophe modeling, ASOP 41 communications, and ASOP 56 model governance.

How to Pass the GH 301 Exam

What You Need to Know

Passing score: Pass mark set by SOA
Assessment: Written-response case study exam covering health data, risk adjustment, care management, quality, value-based care, pharmacy, equity, and ASOPs.
Time limit: ~5 hours
Exam fee: ~$1,275

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

GH 301 Study Tips from Top Performers

1Anchor every concept to a real claims field or code set: paid vs incurred, allowed amount, POS, revenue code, MS-DRG, ICD-10, CPT, HCPCS - GH 301 rewards candidates who reason from data, not slogans.

2Practice writing GLM specifications under exam pressure: Tweedie or Poisson with log link, offset for member months, weights, and a clean interpretation of coefficients in business terms.

3Build a one-page mental model of the major value-based care programs (MSSP, ACO REACH, BPCI Advanced, EOM, PCF/MCP, AHEAD) including risk track, episode vs population, and 2023+ replacements.

4Memorize the current Stars and HEDIS architecture: 1-5 stars, Tukey cut points, ECDS transition, Health Equity Index reward starting 2027, and how QBP and rebate retention flow to plan benefits.

5Drill ASOP 5, 12, 23, 38, 41, and 56 by linking each to the kind of GH 301 prompt that triggers it (liabilities, risk classification, data, catastrophe, communications, model governance).

Frequently Asked Questions

How many questions and how long is SOA GH 301?

GH 301 is a written-response case study exam of approximately 5 hours. SOA does not publish a fixed multiple-choice question count; instead, candidates work through case-based prompts that test analytics, modeling, and management judgment in line with the syllabus weights.

When is SOA GH 301 offered in 2026?

GH 301 is offered three times per year. In 2026 the sittings are scheduled for March, July, and November, consistent with the SOA Group and Health specialty exam calendar. Confirm exact dates and registration windows on the SOA Exam Schedule page.

What is the passing score for GH 301?

SOA sets the pass mark for GH 301 each sitting using its content-based grading process. There is no fixed published percentage cut score. Grades are reported on the standard SOA scale, and candidates are encouraged to focus on demonstrating technical accuracy and clear, supported recommendations under exam conditions.

Which topics carry the most weight on GH 301?

Predictive Modeling for Health is the heaviest section at 20%. Health Data and Analytics, Care Management and UM, Quality Measures, and Population Health and Value-Based Care each carry 15%. Pharmacy Analytics is 10%, and Health Equity/SDoH and ASOPs/Ethics each round out the syllabus at 5%.

What changed for 2026 in the underlying content?

The 2024-2026 environment brought the CMS-HCC V28 phase-in, the CMS-0057-F prior authorization rule, the IRA insulin cap and Part D $2,000 OOP cap (2025), the Humira biosimilar wave (2023), continued GLP-1 expansion, ACO REACH replacing GPDC (2023), EOM replacing OCM (2023), the AHEAD multi-payer model, and the Health Equity Index reward in MA Stars beginning 2027.

Do I need to pass GH 101 before GH 301?

GH 101 is strongly recommended before GH 301 because the analytics and management topics build on the GH 101 benefits and pricing foundation. Candidates should also have ASA designation and be progressing through the FSA Group and Health track. SOA does not require a strict ordering of GH specialty exams, but the GH 101 grounding helps.