1-TPA Price Sheet.xlsx

This is a price sheet for Workers' Compensation Third Party Claims Administration (TPA) and Related Support Services submitted by a vendor in response to a request for proposal from the San Antonio Independent School District (SAISD) in Texas. The price sheet outlines proposed fees across a five-year contract period for comprehensive TPA services and ancillary support offerings. The services encompass TPA service fees, loss control services, medical bill audits with flat rates per bill and specific CPT code categories, hospital bill audits using UB-92 formats, pharmacy bill audits, and pre-authorization services including both medical pre-authorization and retrospective review. Additionally, the vendor proposes medical case management services available in both field-based and telephonic delivery modes, vocational case management on a per-claim basis, and ancillary services including peer review requirements.

The price sheet further details specialized examination and review services such as required medical exams (RME), designated doctor exams (DDE), independent medical exams (IME), independent review organization (IRO) services, and private investigation services, with pricing structured across all five contract years. The proposal was submitted on April 8, 2021, in response to SAISD's contingent award notification that emphasized services would be determined solely by district needs with no guarantee of minimum work volume. The pricing structure accommodates the full contract term with individual line-item rates applicable to each service category across Years 1 through 5, allowing for transparent cost analysis and budgetary planning throughout the contract period.