5-B-1 2027 Medical Stop Loss Vendor Response Exhibits.xls
XLS spreadsheet 290 KB Posted
- Attached to
- District Wide Employee Benefit Services.
- Solicitation number
- RFP 099-2026
- Issued by
- St. Louis County, Missouri
About this file
This document is a vendor response exhibits file for Saint Louis Public Schools' (SLPS) district-wide employee benefit services contract opportunity. The file contains detailed medical plan design verification and pricing exhibits, self-funded medical and stop loss information, administrative service organization (ASO) exhibits, carrier questionnaires, and physician and facility provider network match data. SLPS seeks to contract with qualified firms to provide comprehensive benefit plans for active and retired employees, including medical and prescription drug coverage, employee assistance plans, wellness programs, dental and vision plans, life insurance products, disability coverage (both long-term and short-term), and related services. The RFP requests vendors submit proposals matching or closely approximating existing benefit structures across multiple plan options (Base Plan, Buy-Up 1, and Buy-Up 2) with specific deductible levels, coinsurance percentages, out-of-pocket maximums, and copay structures for various medical services including physician office visits, hospital care, emergency services, preventive care, and prescription drugs.
The exhibits detail pricing for active and retiree populations across multiple coverage categories (employee only, employee plus spouse, employee plus child, and family coverage), with 2026 proposed benefits and rates provided for comparison against current Coventry/Aetna and UHC vendor offerings. Stop loss coverage is quoted with specific deductibles of $350,000 and $500,000, unlimited lifetime maximums, aggregate corridors of 125 percent, and annual aggregate maximums of $1,000,000. Medical geographic access requirements specify minimum provider availability (two primary care physicians and two specialists within 10 miles, one within 20 miles) with corresponding coverage percentage thresholds. The vendor response questionnaire requires extensive documentation of claims administration capabilities, network information, utilization management reporting, member services operations, provider directories, website tools, claim turnaround times, accuracy rates, staffing experience and turnover, and performance guarantees. Historical claims data from 2015 and physician/facility provider disruption analysis are included showing network status designations (participating or non-participating) for major regional providers including Barnes-Jewish Hospital, SSM Health facilities, Mercy Hospital locations, and Washington University physician groups across multiple states.
View the file
Other files
Show all 20
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Medical Geo
| St. Louis Public Schools | |||||
| REQUIRED EXHIBITS - Medical GeoAccess Results | |||||
| CARRIER: | |||||
| QUOTED NETWORK: | |||||
| Full detailed reports for the medical and Rx GEO access are not required at this time. | |||||
| Measurement | Primary Care Physicians | Specialists | Acute Care | ||
| Pediatricians | OB/GYNs | Hospitals | |||
| # of Employees/Zip Codes Evaluated | |||||
| Providers | |||||
| # of Providers | |||||
| # of Locations | |||||
| X Providers within X Miles | 2 w/in 10 miles | 2 w/in 10 miles | 2 w/in 10 miles | 2 w/in 10 miles | 1 w/in 20 miles |
| % of Employee WITH access: | |||||
| # of Employees WITH access: | |||||
| % of Employees WITHOUT access: | |||||
| # of Employees WITHOUT access: | |||||
| Average distance to 2 providers for employees with desired access: | |||||
| Average distance to 2 providers for employees without desired access: |
&C&P
Medical ONLY
| UHC | Vendor: | |||||||||||
| 2026 | Proposed | |||||||||||
| Benefits Requested | Match current benefits | |||||||||||
| Benefits | Base Plan | Buy Up 1 | Buy Up 2 | |||||||||
| DEDUCTIBLE | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* |
| - Individual | $1,500 | $2,000 | $500 | $1,000 | $200 | $400 | ||||||
| - Family | $3,000 | $4,000 | $1,000 | $2,000 | $400 | $800 | ||||||
| - Deductible Status (Emb/Non-Emb) | Embedded | Embedded | Embedded | |||||||||
| COINSURANCE | 70% | 60% | 80% | 70% | 90% | 70% | ||||||
| - Individual Out of Pocket Max | $4,000 | $7,000 | $3,500 | $7,000 | $1,400 | $2,800 | ||||||
| - Family Out of Pocket Max | $8,000 | $14,000 | $7,000 | $14,000 | $2,800 | $5,600 | ||||||
| - Medicare Retirees pay an additional OOP | $300 | $300 | $300 | $300 | $300 | $300 | ||||||
| - Items Included in OOP Max | Med & Rx | Deductible | Med & Rx | Deductible | Med & Rx | Deductible | ||||||
| PHYSICIAN OFFICE VISIT | ||||||||||||
| - Illness or Injury (PCP/Specialist) | $25/$35 Copay | 60% AD | $25/$35 Copay | 70% AD | $15/$30 Copay | 70% AD | ||||||
| - Preventive Care (OV, X-rays, Labs, etc.) | 100% | 60% AD | 100% | 70% AD | 100% | 70% AD | ||||||
| HOSPITAL & EMERGENCY SERVICES | ||||||||||||
| - Inpatient | 70% AD | 60% AD | 80% AD | 70% AD | 90% AD | 70% AD | ||||||
| - Outpatient | 70% AD | 60% AD | 80% AD | 70% AD | 90% AD | 70% AD | ||||||
| - Hospital Emergency Room | $250 Copay | $250 Copay | $250 Copay | $250 Copay | $150 Copay | $150 Copay | ||||||
| - Urgent Care | $40 Copay | 60% AD | $40 Copay | 70% AD | $40 Copay | 70% AD | ||||||
| OTHER SERVICES | ||||||||||||
| - Diagnostic X-rays & Lab | 100% AD | 60% AD | 100% | 70% AD | 100% | 70% AD | ||||||
| - Major Diagnostic (CT, MRI, etc.) | 70% AD | 60% AD | 80% AD | 70% AD | 90% AD | 70% AD | ||||||
| - Chiropractic Services | $20 copay | 60% | $20 Copay | 70% | $20 Copay | 30% | ||||||
| - Therapy (visit limits apply) | $25 Copay | 60% AD | $25 Copay | 70% AD | $15 Copay | 70% AD | ||||||
| EAP Services | Included - telephonic & up to 3 face-to-face assessments | |||||||||||
| MEDICAL PREMIUMS | Base Plan | Buy Up 1 | Buy Up 2 | |||||||||
| Actives | ||||||||||||
| Employee | $788.82 | $859.38 | $1,006.34 | |||||||||
| Employee + Spouse | $1,459.32 | $1,589.85 | $1,861.74 | |||||||||
| Employee + Child | $1,175.36 | $1,289.49 | $1,499.44 | |||||||||
| Family | $1,680.17 | $1,830.46 | $2,143.51 | |||||||||
| EAP - fee only applies to medical waivers | $330 per month to cover up to 250 employees who waived medical coverage | |||||||||||
| Retirees | ||||||||||||
| Employee - Retiree w/ Medicare | $859.38 | $1,006.34 | ||||||||||
| Employee + SP - Ret + Sp w/Medicare | $1,589.85 | $1,861.74 | ||||||||||
| Employee + Child(ren) - Ret + CH w/Medicare | Note: | $1,280.49 | $1,499.44 | |||||||||
| Employee + Family - Family w/Medicare | Retiree Board | $1,830.46 | $2,143.51 | |||||||||
| Ret + Sp w/ Medicare, Ch(ren) w/o | Elected to not | $443.21 | $496.71 | |||||||||
| Ret w/ Medicare, Sp w/o Med | Offer this plan for | $979.50 | $1,076.70 | |||||||||
| SP w/Medicare, Ret w/o Medicare | 2023, however | $988.36 | $1,086.40 | |||||||||
| Ret & Ch (w/ Med), Sp (w/o Med) | rates still need to | $1,564.49 | $1,719.75 | |||||||||
| Ret w/o Med, Sp & Ch(ren) w/ Med | be calculated as they | $1,564.49 | $1,719.75 | |||||||||
| Ret & Sp w/o Med + Child w/Medicare | can choose to add it | $1,148.92 | $1,262.92 | |||||||||
| Ret w/ Medicare; CH w/o | for 2024. | $1,148.92 | $1,262.92 | |||||||||
| Ret w/o Med + Child w/Med | $1,396.36 | $1,534.27 | ||||||||||
| Surv w Medicare | $1,396.36 | $1,534.27 | ||||||||||
| Surv w Medicare + Ch w/o | $1,856.30 | $2,173.73 | ||||||||||
| Surv w/o Medicare, CH w/Med | $988.36 | $1,086.40 | ||||||||||
| Surv + CH w/Medicare | $1,298.57 | $1,520.58 |
&C&"Tahoma,Bold"&20St. Louis Public Schools&18 Medical Plan Design Verification and Pricing Exhibit - MEDICAL ONLY Proposed Effective Date: January 1, 2017 Attachment B-1 &CThe above analysis is for illustrative purposes only. Please refer to contract and/or proposal for details. Final rates are determined by many variables - see Disclosures Page for further details.
USI - Confidential && Proprietary&RPage &P
Medical & Rx
| Coventry/Aetna | Vendor | |||||||
| 2015 Current | Proposed | |||||||
| Benefits Requested | Please match as close as possible, if you are unable to match Rx structure please quote your standard. | |||||||
| Benefits | Base Plan | Buy-up Plan | ||||||
| DEDUCTIBLE | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* | In Network | Out of Network* |
| - Individual | $500 | $1,000 | $200 | $400 | ||||
| - Family | $1,000 | $2,000 | $400 | $800 | ||||
| - Deductible Status (Emb/Non-Emb) | Embedded | Embedded | ||||||
| COINSURANCE | 80% | 70% | 90% | 70% | ||||
| - Individual Out of Pocket Max | $3,500 | $7,000 | $1,400 | $2,800 | ||||
| - Family Out of Pocket Max | $7,000 | $14,000 | $2,800 | $5,600 | ||||
| - Medicare Retirees pay an additional OOP | $300 | $300 | $300 | $300 | ||||
| - Items Included in OOP Max | Ded, Med, & Rx Copays | Deductible | Ded, Med, & Rx Copays | Deductible | ||||
| PHYSICIAN OFFICE VISIT | ||||||||
| - Illness or Injury (PCP/Specialist) | $25/$35 Copay | 70% AD | $15/$30 Copay | 70% AD | ||||
| - Preventive Care (OV, X-rays, Labs, etc.) | 100% | 70% AD | 100% | 70% AD | ||||
| HOSPITAL & EMERGENCY SERVICES | ||||||||
| - Inpatient | 80% AD | 70% AD | 90% AD | 70% AD | ||||
| - Outpatient | 80% AD | 70% AD | 90% AD | 70% AD | ||||
| - Hospital Emergency Room | $250 Copay | $250 Copay | $150 Copay | $150 Copay | ||||
| - Urgent Care | $75 Copay | 70% AD | $50 Copay | 70% AD | ||||
| OTHER SERVICES | ||||||||
| - Diagnostic X-rays & Lab | 100% | 70% AD | 100% | 70% AD | ||||
| - Major Diagnostic (CT, MRI, etc.) | 80% AD | 70% AD | 90% AD | 70% AD | ||||
| - Chiropractic Services | $20 Copay | 70% AD | $20 Copay | 70% AD | ||||
| - Therapy (visit limits apply) | $25 Copay | 70% AD | $15 Copay | 70% AD | ||||
| PRESCRIPTION DRUG BENEFITS | ||||||||
| Retail Copay | Prescription Drug Plan is self funded with Express Scripts. The copay is based on the cost of the drug. If the actual cost of the drug is less than the copay, the member pays the actual cost. | |||||||
| Tier 1 - $0 to $40 | $10 Copay (drug cost of $10-$40) | $10 Copay (drug cost of $10-$40) | ||||||
| Tier 2 - $40.01 to $80 | $25 Copay (drug cost of $40.01-$80) | $20 Copay (drug cost of $40.01-$80) | ||||||
| Tier 3 - $80.01 and over | $40 Copay (drug cost of $80.01 & above) | $40 Copay (drug cost of $80.01 & above) | ||||||
| Mail Order Copay | ||||||||
| Tier 1 - $0 to $80 | $20 Copay (drug cost of $20-$80) | $20 Copay (drug cost of $20-$80) | ||||||
| Tier 2 - $80.01 to $160 | $50 Copay (drug cost of $80.01-$160) | $40 Copay (drug cost of $80.01-$160) | ||||||
| Tier 3 - $160.01 and over | $80 Copay (drug cost of $160.01 & above) | $80 Copay (drug cost of $160.01 & above) | ||||||
| EAP Services | Included - telephonic & up to 3 face-to-face assessments | |||||||
| MEDICAL WITH RX PREMIUMS | Low Plan (Base) | High Plan (Buy-Up) | ||||||
| Actives | ||||||||
| Employee | ||||||||
| Employee + Spouse | ||||||||
| Employee + Child | ||||||||
| Family | ||||||||
| EAP - fee only applies to medical waivers | ||||||||
| Retirees | ||||||||
| Non-Medicare Employee | ||||||||
| Non-Medicare Employee+Spouse | ||||||||
| Non-Medicare Employee+Children | ||||||||
| Non-Medicare Family | ||||||||
| Retiree on Medicare | ||||||||
| Retiree & Spouse on Medicare | ||||||||
| Ret on Medicare w/ children | ||||||||
| Ret, Sp, Child (all with Medicare) | ||||||||
| Ret w/ch (all on Medicare) | ||||||||
| Ret, sSp (w/ Medicare), child (w/o Med) | ||||||||
| Retiree with Medicare, Spouse w/o | ||||||||
| Retiree without Medicare, Spouse with | ||||||||
| Ret & Child (w/ Med), Sp (w/o Med) | ||||||||
| Retiree w/o med, Sp & Chld (with Med) |
&C&"Tahoma,Bold"&20St. Louis Public Schools&18 Medical Plan Design Verification and Decrement Pricing Exhibit - MEDICAL && RX Proposed Effective Date: January 1, 2017 &CThe above analysis is for illustrative purposes only. Please refer to contract and/or proposal for details. Final rates are determined by many variables - see Disclosures Page for further details.
USI - Confidential && Proprietary&RPage &P
ASO Medical Admin
| St. Louis Public Schools | |
| REQUIRED EXHIBITS - Self Funded Medical & Stop Loss Exhibit | |
| Carrier Name: | |
| Administrative Fee Breakdown (PEPM) | Proposed January 1, 2024 |
| Claims Administration | |
| Medical Claims Processing / Administration Fee | |
| - Year 1 | |
| - Year 2 | |
| - Year 3 | |
| Utilization Management / Review Fee | |
| Network Information | |
| Network Quoted | |
| Network Administration / Access Fee | |
| Additional Services / Fees | |
| Pharmacy Interface Fee | |
| Set-up / Renewal Fee | |
| Optional Services | |
| 24-hour Nurse / Information Line (PEPM) | |
| Banking Charges / Fees | |
| Centers of Excellent (Transplant Network) | |
| COBRA Administration | |
| Directories / Fulfillment (Each) | |
| Disease Management (PEPM) | |
| Enrollment / Eligibility System Access | |
| HIPAA Certificates | |
| ID Cards - Initial (Each) | |
| ID Cards - Replacement (Each) | |
| Large Case Management (per Hour) | |
| Maternity Management (PEPM) | |
| Physician Review | |
| Reporting - Standard | |
| Required Banking Deposit | |
| Schedule A Preparation | |
| SPD/Booklet Printing & Distribution | |
| SPD/Booklet Set-up | |
| Subrogation | |
| Wellness Program / Components Available | |
| Other (please state) |
&C&P
Stop Loss Exhibit
| St. Louis Public Schools | ||||||
| REQUIRED EXHIBITS - Stop Loss Exhibit | ||||||
| Stop Loss Carrier Name: | ||||||
| Proposed TPA/UR Vendor: | ||||||
| Fee Breakdown (PEPM) | Proposed Option 1 - 12/12 | Proposed Option 2 - 12/15 | Proposed Option 3 - 12/12 | Proposed Option 4 - 12/15 | ||
| SPECIFIC | REQUESTED: | REQUESTED: | ||||
| Stoploss Deductible | $350,000 | $500,000 | ||||
| Aggregating Specific | None | None | ||||
| Lifetime Maximum | UNLIMITED | UNLIMITED | ||||
| Contract type | 12/12 & 12 / 15 | 12/12 & 12 / 15 | ||||
| Covered Benefits | Medical/Rx | Medical/Rx | ||||
| Specific Rate - Composite | ||||||
| Aggregate | REQUESTED: | REQUESTED: | ||||
| Covered Benefits | Medical/Rx | Medical/Rx | ||||
| Aggregate Corridor | 125% | 125% | ||||
| Annual Aggregate Maximum | $1,000,000 | $1,000,000 | ||||
| Attachment Point | ||||||
| Expected - Composite | ||||||
| Maximum - Composite | ||||||
| Aggregate Premium | ||||||
| General Information | REQUESTED: | REQUESTED: | ||||
| Run-In Limitation | NONE | NONE | ||||
| Lock-in Date | 90 DAYS | 90 DAYS | ||||
| Disclosure Required at Renewal? | NONE | NONE | ||||
| Laser at Renewal? | OPTIONAL | OPTIONAL | ||||
| Monthly Aggregate Accomodation | INCLUDED | INCLUDED | ||||
| Retirees Included in Quote? | INCLUDED | INCLUDED |
&C&P
Medical Questionnaire
| St. Louis Public Schools | |
| REQUIRED EXHIBITS - Insured Carrier Questionnaire | |
| CARRIER: | |
| Please note that in order for your quote to be considered, you must complete the questionnaire in the table provided below. | |
| Please answer each question briefly, additional information will be requested at a later date. | |
| Management Information | Vendor Responses |
| Who would have primary account management responsibility for Client? | |
| Where is this person located? | |
| Please provide a sample of your utilization management reports. | |
| Please identify what large claim information is provided and frequency of data. Provide Samples. | |
| Are these reports paper or web-based? | |
| Are these reports available on a monthly or quarterly basis? | |
| What ad hoc capabilities are available on your website? | |
| Utilization and paid claims, will be required on a monthly basis by the 15th of the month. Please confirm that you can accommodate this requirement. | |
| Is your organization willing to have a combined strategy meeting with other benefits vendors (pharmacy, dental, etc.)? | |
| Will these reports be available online? Will they be in a downloadable format that can be manipulated (such as Excel)? | |
| Client tracks claims in numerous ways, including actives, COBRA participants, retirees, over and under 65, for example. Please confirm that you can accommodate this type of claim tracking. | |
| Define the criteria under which you would re-evaluate the rates, fees and factors. | |
| Communication & Administration | |
| What communication materials are included in your pricing? Please be specific. | |
| What enrollment meeting support do you provide? Is it included in your pricing? | |
| What is your recommended communications method for employees who cannot attend enrollment meetings? | |
| What is your deadline to receive eligibility in order for you to guarantee that ID cards will be received before the effective date? | |
| Do you draft the SPD? | |
| Please provide an estimated implementation timeline assuming a 1/1/23 effective date. | |
| Structure and Stability | Vendor Response |
| What is your 2023 target per member per month (PMPM) medical cost for your network? | |
| What was your historic PMPM medical cost for the quoted network? | |
| What was your average inpatient discount in the area? | |
| What was your average outpatient discount in the area? | |
| What was your average physician discount in the area? | |
| What is your average contracted facility rate in each market? | |
| What was your average ancillary discount, by type, in the area? | |
| Are your local networks owned or rented? | |
| Are you willing to place guarantees on provider discounts attained? Please provide the structure of the guarantee. | |
| Claim Services | Vendor Responses |
| Where would the primary claim-paying unit be located for Client? | |
| For the above mentioned office, what was your average claim turnaround time in calendar days for 2022/2023? | |
| For the above-mentioned office, what was your claim payment procedural accuracy percentage for 2022/2023? | |
| For the above-mentioned office, what was your claim payment financial accuracy percentage for 2022/2023? | |
| For the above-mentioned office, what percentage of claims were automatically electronically adjudicated in 2022/2023? | |
| For which services and to who, do you outsource the following: | |
| Mental health | |
| Prescription drug | |
| Laboratory | |
| Network management | |
| Utilization management | |
| Subrogation | |
| Other services? | |
| What is your best estimate of the average years’ experience of your claims examiner staff? (You may include experience outside of this organization.) | |
| Will this be a Client dedicated team? If not, how many other clients will this team cover? | |
| Identify staff turnover rate for the last 12 months? | |
| Are claims processors also responsible for answering telephones? | |
| Under what circumstances do you deny or pend a claim for COB investigation? | |
| Member Services | |
| Please provide results from the following surveys for both 2022 and 2023. | |
| Member satisfaction | |
| Provider satisfaction | |
| Benefit manager satisfaction | |
| Where would the primary member service unit for Client be located? | |
| What are your weekday and weekend hours of operation for telephone member services? | |
| What provision do you have for handling after-hours telephone calls or emergency requests? | |
| Do members have email access to customer service? | |
| What is your best estimate of the average years’ experience of your member services staff? (You can include experience outside of this organization.) | |
| Will this be a Client-dedicated member services team? If not, how many other clients will this team cover? | |
| Identify member services staff turnover rate for the last 12 months. | |
| Does the member services staff have the ability to make online corrections to the claim systems when additional information is received? | |
| Customer and Consumer Tools | |
| Are provider directories available on your website? How often are they updated? | |
| Who is the provider of your web-based health information? | |
| What medical library information is available online? | |
| Do you have disease-specific information online? | |
| Do you have disease-specific chat rooms and support groups? | |
| Are your medical web tools interactive, i.e., do they provide members with specific questions to ask their doctors based on diseases/symptoms with input by the member? | |
| Does your website provide market and average network pricing for procedures? | |
| Does your website provide provider-specific pricing? | |
| If your website provides provider/facility cost and outcomes measurements, does it also identify which are in-network and which are out-of-network? | |
| Can members request ID cards on your website? | |
| Can the employee view his/her dependent claims the website? | |
| Describe the information available to employees regarding claim activity for each of their participating dependents. | |
| How quickly are claims processing information available on the website? | |
| Can members print EOBs from the website? | |
| How often are employee statements mailed? | |
| If any of these processes or services described above are not included in your standard pricing, please note. | |
| NOTE: Please provide the website address where we can demo the tools that are available to members. |
Page &P of &N
Physician Match
| PLEASE INDICATE NETWORK STATUS (IN OR OUT) FOR THE NETWORK YOU ARE QUOTING. | CARRIER: | ||||||||
| QUOTED NETWORK: | |||||||||
| Physician Name | State | Provider Participation Status Category | Provider TIN | Number of Claimants | Number of Visits | Number of Services | Covered Amount | Total Net Paid | Network Status |
| SSM HEALTH CARE GROUP | MISSOURI | Participating Provider | 880988603 | 606 | 2,450 | 3,680 | $571,481 | $456,679 | |
| UNKNOWN | 880988603 | 1 | 0 | 1 | $147 | $147 | |||
| Subtotal | '-- | 2,450 | 3,681 | $571,628 | $456,826 | ||||
| WUSM IM INTERNAL MEDICINE | ILLINOIS | Participating Provider | 430653611 | 320 | 1,038 | 1,640 | $273,870 | $237,667 | |
| MISSOURI | Participating Provider | 430653611 | 224 | 642 | 1,073 | $193,664 | $158,964 | ||
| Subtotal | '-- | 1,680 | 2,713 | $467,534 | $396,631 | ||||
| WUSM RADIOLOGY | ILLINOIS | Participating Provider | 430653611 | 545 | 1,152 | 1,692 | $301,004 | $260,093 | |
| MISSOURI | Participating Provider | 430653611 | 326 | 572 | 866 | $153,951 | $127,822 | ||
| Subtotal | '-- | 1,724 | 2,558 | $454,955 | $387,915 | ||||
| MERCY CLN EAST COMMUNTIES | ILLINOIS | Participating Provider | 431771217 | 717 | 1,791 | 2,976 | $330,868 | $290,101 | |
| Subtotal | '-- | 1,791 | 2,976 | $330,868 | $290,101 | ||||
| PHYSICIANS GROUPS | MISSOURI | Participating Provider | 431681957 | 584 | 1,611 | 2,540 | $325,383 | $287,222 | |
| Non-Participating Provider | 431681957 | 2 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 1,611 | 2,540 | $325,383 | $287,222 | ||||
| SSM MEDICAL GROUP | MISSOURI | Participating Provider | 431664107 | 527 | 1,394 | 2,549 | $290,475 | $238,131 | |
| Non-Participating Provider | 431664107 | 4 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 1,394 | 2,549 | $290,475 | $238,131 | ||||
| CEP AMERICA | CALIFORNIA | Participating Provider | 271369141 | 199 | 270 | 270 | $136,644 | $136,279 | |
| Subtotal | '-- | 270 | 270 | $136,644 | $136,279 | ||||
| WUSM EMERGENCY MEDICINE | ILLINOIS | Participating Provider | 430653611 | 129 | 202 | 305 | $83,166 | $82,525 | |
| MISSOURI | Participating Provider | 430653611 | 92 | 127 | 138 | $52,582 | $52,483 | ||
| Subtotal | '-- | 329 | 443 | $135,748 | $135,008 | ||||
| WUSM OB GYN | ILLINOIS | Participating Provider | 430653611 | 93 | 205 | 305 | $78,015 | $68,461 | |
| MISSOURI | Participating Provider | 430653611 | 49 | 112 | 152 | $47,249 | $37,963 | ||
| Subtotal | '-- | 317 | 457 | $125,264 | $106,424 | ||||
| WUSM ORTHOPEDIC SURGERY | ILLINOIS | Participating Provider | 430653611 | 98 | 195 | 326 | $108,002 | $77,053 | |
| MISSOURI | Participating Provider | 430653611 | 64 | 103 | 149 | $32,188 | $23,909 | ||
| Subtotal | '-- | 298 | 475 | $140,190 | $100,962 | ||||
| SSM HEALTH MEDICAL GROUP | MISSOURI | Participating Provider | 431664107 | 280 | 588 | 1,220 | $110,864 | $94,186 | |
| Subtotal | '-- | 588 | 1,220 | $110,864 | $94,186 | ||||
| WUSM RADIATION ONCOLOGY | ILLINOIS | Participating Provider | 430653611 | 11 | 80 | 118 | $47,166 | $46,960 | |
| MISSOURI | Participating Provider | 430653611 | 9 | 77 | 109 | $42,526 | $37,322 | ||
| Subtotal | '-- | 157 | 227 | $89,692 | $84,282 | ||||
| FAIRVIEW HEIGHTS MEDICAL GROUP, S.C. | MISSOURI | Participating Provider | 364147189 | 197 | 568 | 773 | $104,557 | $84,015 | |
| Non-Participating Provider | 364147189 | 1 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 568 | 773 | $104,557 | $84,015 | ||||
| METRO WEST ANESTHESIA GROUP | MISSOURI | Participating Provider | 431648309 | 138 | 132 | 164 | $102,473 | $80,613 | |
| Subtotal | '-- | 132 | 164 | $102,473 | $80,613 | ||||
| MERCY CLINIC NEUROLOGY | ILLINOIS | Participating Provider | 861176023 | 26 | 46 | 82 | $84,806 | $78,211 | |
| Subtotal | '-- | 46 | 82 | $84,806 | $78,211 | ||||
| WUSM OPHTHALMOLOGY | ILLINOIS | Participating Provider | 430653611 | 55 | 90 | 180 | $71,673 | $57,170 | |
| MISSOURI | Participating Provider | 430653611 | 49 | 63 | 134 | $21,525 | $17,060 | ||
| Subtotal | '-- | 153 | 314 | $93,198 | $74,230 | ||||
| WUSM PATHOLOGY | ILLINOIS | Participating Provider | 430653611 | 106 | 125 | 266 | $34,420 | $32,414 | |
| MISSOURI | Participating Provider | 430653611 | 84 | 101 | 185 | $31,165 | $27,912 | ||
| Subtotal | '-- | 226 | 451 | $65,585 | $60,326 | ||||
| AMERICAN MULTISPECIALTY GROUP | MISSOURI | Participating Provider | 431383893 | 161 | 391 | 1,351 | $64,715 | $59,489 | |
| Non-Participating Provider | 431383893 | 3 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 391 | 1,351 | $64,715 | $59,489 | ||||
| WEST COUNTY RADIOLOGICAL GRP | INDIANA | Participating Provider | 430917818 | 318 | 449 | 731 | $43,409 | $33,966 | |
| MISSOURI | Participating Provider | 430917818 | 146 | 209 | 333 | $24,403 | $19,776 | ||
| Subtotal | '-- | 658 | 1,064 | $67,812 | $53,742 | ||||
| STEVEN BAAK MD | MISSOURI | Participating Provider | 474386121 | 7 | 32 | 54 | $58,554 | $51,927 | |
| Subtotal | '-- | 32 | 54 | $58,554 | $51,927 | ||||
| WUSM PEDIATRICS | ILLINOIS | Participating Provider | 430653611 | 55 | 112 | 168 | $39,824 | $29,542 | |
| MISSOURI | Participating Provider | 430653611 | 34 | 75 | 117 | $24,976 | $20,309 | ||
| Subtotal | '-- | 187 | 285 | $64,800 | $49,852 | ||||
| WESTERN ANESTHESIOLOGY ASSOC | MISSOURI | Participating Provider | 430959561 | 75 | 132 | 138 | $54,083 | $42,424 | |
| Subtotal | '-- | 132 | 138 | $54,083 | $42,424 | ||||
| WUSM NEUROLOGY | ILLINOIS | Participating Provider | 430653611 | 38 | 60 | 79 | $28,438 | $27,102 | |
| MISSOURI | Participating Provider | 430653611 | 27 | 30 | 44 | $15,507 | $14,327 | ||
| Subtotal | '-- | 90 | 123 | $43,945 | $41,429 | ||||
| MERCY CLINIC MATERNAL FETAL MEDICINE | ILLINOIS | Participating Provider | 822496814 | 32 | 179 | 244 | $41,329 | $38,618 | |
| Subtotal | '-- | 179 | 244 | $41,329 | $38,618 | ||||
| SSM HEALTH SLU HOSPITAL ANESTHESIA | MISSOURI | Participating Provider | 364814355 | 29 | 63 | 67 | $34,504 | $32,629 | |
| Subtotal | '-- | 63 | 67 | $34,504 | $32,629 | ||||
| INNOVATIVE INFUSIONS/ PRO FEES | TEXAS | Participating Provider | 900213778 | 2 | 3 | 14 | $35,266 | $31,782 | |
| Subtotal | '-- | 3 | 14 | $35,266 | $31,782 | ||||
| SAINT LOUIS RHEUMATOLOGY | MISSOURI | Participating Provider | 431907813 | 8 | 36 | 87 | $37,123 | $30,358 | |
| Subtotal | '-- | 36 | 87 | $37,123 | $30,358 | ||||
| WUCA SOUTHWEST PEDIATRICS | ILLINOIS | Participating Provider | 320554062 | 44 | 76 | 221 | $15,404 | $15,404 | |
| MISSOURI | Participating Provider | 320554062 | 34 | 62 | 204 | $13,806 | $13,784 | ||
| Subtotal | '-- | 138 | 425 | $29,210 | $29,189 | ||||
| WUSM OTOLARYNGOLOGY | ILLINOIS | Participating Provider | 430653611 | 44 | 73 | 105 | $22,365 | $15,947 | |
| MISSOURI | Participating Provider | 430653611 | 30 | 50 | 82 | $20,746 | $12,568 | ||
| Subtotal | '-- | 123 | 187 | $43,111 | $28,515 | ||||
| UROLOGY OF ST LOUIS | MISSOURI | Participating Provider | 430835090 | 87 | 242 | 536 | $40,533 | $28,370 | |
| Subtotal | '-- | 242 | 536 | $40,533 | $28,370 | ||||
| MERCY CLN SURG SPEC | ILLINOIS | Participating Provider | 272481555 | 90 | 169 | 281 | $41,409 | $27,630 | |
| Non-Participating Provider | 272481555 | 1 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 169 | 281 | $41,409 | $27,630 | ||||
| WASHU COMMUNITY SPECIALISTS | ILLINOIS | Participating Provider | 331428277 | 40 | 54 | 61 | $25,832 | $25,832 | |
| Subtotal | '-- | 54 | 61 | $25,832 | $25,832 | ||||
| HSHS MEDICAL GROUP | MISSOURI | Participating Provider | 263956318 | 48 | 169 | 352 | $29,791 | $24,252 | |
| Subtotal | '-- | 169 | 352 | $29,791 | $24,252 | ||||
| MERCY CLINIC GASTRO | ILLINOIS | Participating Provider | 264777940 | 64 | 80 | 102 | $28,655 | $22,725 | |
| Subtotal | '-- | 80 | 102 | $28,655 | $22,725 | ||||
| MISSOURI BAPTIST MC/PROF FEES | MISSOURI | Participating Provider | 430652656 | 33 | 38 | 53 | $29,530 | $21,488 | |
| Subtotal | '-- | 38 | 53 | $29,530 | $21,488 | ||||
| MERCY HOSPITAL ST LOUIS/PRO FEE | ILLINOIS | Participating Provider | 430653493 | 100 | 133 | 147 | $25,546 | $20,949 | |
| Non-Participating Provider | 430653493 | 1 | 1 | 1 | $80 | $80 | |||
| Subtotal | '-- | 134 | 148 | $25,625 | $21,029 | ||||
| WUCA CONSULTANTS IN WOMEN'S HEALTHCARE | ILLINOIS | Participating Provider | 430653611 | 22 | 36 | 54 | $9,756 | $9,274 | |
| MISSOURI | Participating Provider | 430653611 | 16 | 19 | 28 | $11,828 | $11,508 | ||
| Subtotal | '-- | 55 | 82 | $21,584 | $20,782 | ||||
| ESSE HEALTH | MISSOURI | Participating Provider | 431383893 | 91 | 146 | 455 | $21,736 | $19,373 | |
| Subtotal | '-- | 146 | 455 | $21,736 | $19,373 | ||||
| WUSM NEURO SURGERY | MISSOURI | Participating Provider | 430653611 | 10 | 14 | 19 | $20,884 | $19,152 | |
| Subtotal | '-- | 14 | 19 | $20,884 | $19,152 | ||||
| SYNERGY ENT SPECIALISTS | MISSOURI | Participating Provider | 431854742 | 4 | 5 | 65 | $21,124 | $17,201 | |
| Subtotal | '-- | 5 | 65 | $21,124 | $17,201 | ||||
| ORTHOPEDIC ASSOCIATES | MISSOURI | Participating Provider | 431903482 | 28 | 67 | 161 | $23,132 | $17,100 | |
| Non-Participating Provider | 431903482 | 1 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 67 | 161 | $23,132 | $17,100 | ||||
| MIDWEST ANESTHESIA PROVIDERS | OHIO | Non-Participating Provider | 811355215 | 4 | 5 | 5 | $1,758 | $1,758 | |
| UNKNOWN | 811355215 | 28 | 31 | 42 | $17,146 | $14,574 | |||
| Subtotal | '-- | 36 | 47 | $18,904 | $16,332 | ||||
| FAMILY CARE HEALTH CTRS | MISSOURI | Participating Provider | 237076112 | 55 | 176 | 330 | $17,830 | $14,757 | |
| Non-Participating Provider | 237076112 | 2 | 0 | 0 | $0 | $0 | |||
| Subtotal | '-- | 176 | 330 | $17,830 | $14,757 | ||||
| CEPAMERICA ILLINOIS | CALIFORNIA | Participating Provider | 263711283 | 24 | 28 | 28 | $14,371 | $14,371 | |
| Subtotal | '-- | 28 | 28 | $14,371 | $14,371 | ||||
| WASHINGTON UNIVERSITY PHYSICIANS IN IL | ILLINOIS | Participating Provider | 822026363 | 25 | 48 | 72 | $14,871 | $14,227 | |
| Subtotal | '-- | 48 | 72 | $14,871 | $14,227 | ||||
| MERCY CLN HEART & VASCUL | ILLINOIS | Participating Provider | 412175615 | 94 | 197 | 239 | $16,868 | $13,909 | |
| Subtotal | '-- | 197 | 239 | $16,868 | $13,909 | ||||
| OBSTETRICAL ANESTHESIA ASSOC | MISSOURI | Participating Provider | 431170100 | 18 | 18 | 42 | $14,710 | $13,547 | |
| Subtotal | '-- | 18 | 42 | $14,710 | $13,547 | ||||
| WASHINGTON UNIVERSITY CLINICAL ASSOCIATE | ILLINOIS | Participating Provider | 611696383 | 28 | 51 | 175 | $13,670 | $13,483 | |
| Subtotal | '-- | 51 | 175 | $13,670 | $13,483 | ||||
| ORTHOMED STAFFING | TEXAS | UNKNOWN | 831147073 | 11 | 12 | (90) | $13,181 | $13,181 | |
| Subtotal | '-- | 12 | (90) | $13,181 | $13,181 | ||||
| OPHTHALMOLOGY CONSULTANTS | ILLINOIS | Participating Provider | 431926841 | 31 | 63 | 143 | $20,409 | $12,558 | |
| Subtotal | '-- | 63 | 143 | $20,409 | $12,558 |
&C&"Tahoma,Bold"&20St. Louis Public Schools&18 Physician Provider Disruption Using Claims data 1/1/15 - 12/31/15 (paid thru 1/31/2016) &CThe above analysis is for illustrative purposes only. Please refer to contract and/or proposal for details. Final rates are determined by many variables - see Disclosures Page for further details.
USI - Confidential && Proprietary&RPage &P
Facility Match
| PLEASE INDICATE NETWORK STATUS (IN OR OUT) FOR THE NETWORK YOU ARE QUOTING. | CARRIER: | ||||||||||||
| QUOTED NETWORK: | |||||||||||||
| Hospital Name | City | State | Provider Participation Status Category | Provider TIN | Number of Inpatient Admissions | Number of Inpatient Days | Inpatient Covered Amount | Inpatient Total Net Paid | Outpatient Number of Services | Outpatient Covered Amount | Outpatient Total Net Paid | Network Status | |
| BARNES-JEWISH HOSPITAL | ATLANTA | GEORGIA | Participating Provider | 237309937 | 2 | 14 | $38,823 | $27,515 | 0 | $0 | $0 | ||
| CHICAGO | ILLINOIS | Participating Provider | 237309937 | 14 | 48 | $484,068 | $467,639 | 103 | $747,382 | $681,361 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 237309937 | 35 | 187 | $1,862,118 | $1,801,002 | 156 | $1,148,336 | $1,045,233 | |||
| Subtotal | 51 | 249 | $2,385,009 | $2,296,156 | 259 | $1,895,718 | $1,726,594 | ||||||
| SSM HEALTH SAINT LOUIS UNIVERSITY HOSP | CHICAGO | ILLINOIS | Participating Provider | 474196634 | 4 | 8 | $43,066 | $37,677 | 35 | $129,315 | $114,220 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 474196634 | 23 | 102 | $1,451,188 | $1,408,982 | 77 | $297,606 | $269,376 | |||
| Subtotal | 27 | 110 | $1,494,254 | $1,446,659 | 112 | $426,921 | $383,596 | ||||||
| CHRISTIAN NE/NW | CHICAGO | ILLINOIS | Participating Provider | 436057893 | 5 | 82 | $913,269 | $908,121 | 48 | $121,771 | $113,182 | ||
| CINCINNATI | OHIO | Participating Provider | 436057893 | 0 | 0 | $0 | $0 | 57 | $160,028 | $135,916 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 436057893 | 19 | 69 | $438,679 | $407,516 | 52 | $150,026 | $138,169 | |||
| Subtotal | 24 | 151 | $1,351,948 | $1,315,637 | 157 | $431,825 | $387,267 | ||||||
| MERCY HOSPITAL ST LOUIS | BALLWIN | MISSOURI | Participating Provider | 430653493 | 0 | 0 | $0 | $0 | 20 | $140,978 | $104,636 | ||
| CHICAGO | ILLINOIS | Participating Provider | 430653493 | 33 | 137 | $644,618 | $530,209 | 50 | $174,462 | $134,299 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 430653493 | 1 | 3 | $13,712 | $9,786 | 73 | $195,632 | $173,850 | |||
| Subtotal | 34 | 140 | $658,330 | $539,996 | 143 | $511,072 | $412,786 | ||||||
| MISSOURI BAPTIST MEDICAL CENTER | CHICAGO | ILLINOIS | Participating Provider | 430652656 | 1 | 4 | $16,277 | $15,165 | 32 | $171,078 | $152,920 | ||
| CINCINNATI | OHIO | Participating Provider | 430652656 | 0 | 0 | $0 | $0 | 9 | $32,300 | $28,354 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 430652656 | 17 | 69 | $487,362 | $458,988 | 57 | $316,055 | $287,236 | |||
| Subtotal | 18 | 73 | $503,639 | $474,153 | 98 | $519,433 | $468,510 | ||||||
| SSM HEALTH ST MARYS HOSPITAL ST LOUIS | CHICAGO | ILLINOIS | Participating Provider | 431343281 | 8 | 14 | $91,529 | $75,863 | 78 | $103,211 | $79,293 | ||
| MODESTO | CALIFORNIA | Participating Provider | 431343281 | 0 | 0 | $0 | $0 | 123 | $200,220 | $172,385 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 431343281 | 31 | 72 | $387,506 | $327,590 | 70 | $320,422 | $266,436 | |||
| Subtotal | 39 | 86 | $479,035 | $403,453 | 271 | $623,853 | $518,114 | ||||||
| SSM HEALTH DEPAUL HOSPITAL | CHICAGO | ILLINOIS | Participating Provider | 431343281 | 6 | 10 | $56,695 | $49,808 | 48 | $121,499 | $101,515 | ||
| LOS ANGELES | CALIFORNIA | Participating Provider | 431343281 | 4 | 28 | $155,748 | $144,296 | 5 | $49,346 | $41,915 | |||
| SAINT LOUIS | MISSOURI | Participating Provider | 431343281 | 4 | 23 | $122,870 | $112,972 | 19 | $79,710 | $55,923 | |||
| Subtotal | 14 | 61 | $335,313 | $307,077 | 72 | $250,554 | $199,354 | ||||||
| ST LOUIS CHILDRENS HOSPITAL | CHICAGO | ILLINOIS | Participating Provider | 430654870 | 1 | 1 | $22,404 | $20,885 | 10 | $58,743 | $48,473 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 430654870 | 5 | 26 | $326,412 | $298,469 | 12 | $49,038 | $38,592 | |||
| Subtotal | 6 | 27 | $348,816 | $319,354 | 22 | $107,781 | $87,065 | ||||||
| MERCY HOSPITAL SOUTH | CHICAGO | ILLINOIS | Participating Provider | 430980256 | 12 | 37 | $228,952 | $210,560 | 43 | $110,879 | $93,177 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 430980256 | 1 | 4 | $12,823 | $12,823 | 10 | $44,611 | $34,786 | |||
| TOLEDO | OHIO | Participating Provider | 430980256 | 0 | 0 | $0 | $0 | 7 | $56,714 | $44,911 | |||
| Subtotal | 13 | 41 | $241,775 | $223,383 | 60 | $212,204 | $172,874 | ||||||
| MEMORIAL HOSPITAL | CINCINNATI | OHIO | Participating Provider | 370635502 | 0 | 0 | $0 | $0 | 44 | $148,550 | $134,774 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 370635502 | 8 | 19 | $145,064 | $137,114 | 10 | $66,744 | $55,378 | |||
| Subtotal | 8 | 19 | $145,064 | $137,114 | 54 | $215,294 | $190,153 | ||||||
| BARNES-JEWISH WEST CNTY HOSPIT | CHICAGO | ILLINOIS | Participating Provider | 431527130 | 0 | 0 | $0 | $0 | 25 | $91,397 | $86,737 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 431527130 | 1 | 0 | $2,029 | $1,224 | 35 | $238,019 | $209,536 | |||
| Subtotal | 1 | 0 | $2,029 | $1,224 | 60 | $329,417 | $296,273 | ||||||
| SSM SELECT REHAB ST LOUIS | CHICAGO | ILLINOIS | Participating Provider | 263694972 | 1 | 40 | $172,783 | $171,794 | 0 | $0 | $0 | ||
| Subtotal | 1 | 40 | $172,783 | $171,794 | 0 | $0 | $0 | ||||||
| TOTAL ACCESS URGENT CARE | BALLWIN | MISSOURI | Participating Provider | 261393906 | 0 | 0 | $0 | $0 | 315 | $63,761 | $51,757 | ||
| NASHVILLE | TENNESSEE | Participating Provider | 261393906 | 0 | 0 | $0 | $0 | 671 | $139,693 | $114,710 | |||
| Subtotal | 0 | 0 | $0 | $0 | 986 | $203,454 | $166,466 | ||||||
| ST LUKES EPISCOP-PRESBY HOSPITALS | SAINT LOUIS | MISSOURI | Participating Provider | 430652680 | 1 | 2 | $19,699 | $15,976 | 22 | $63,505 | $54,972 | ||
| SALT LAKE CITY | UTAH | Participating Provider | 430652680 | 0 | 0 | $0 | $0 | 91 | $95,425 | $86,386 | |||
| Subtotal | 1 | 2 | $19,699 | $15,976 | 113 | $158,930 | $141,358 | ||||||
| ST ELIZABETH HOSPITAL | KANSAS CITY | MISSOURI | Participating Provider | 370663567 | 1 | 4 | $25,445 | $21,719 | 14 | $47,357 | $43,640 | ||
| MODESTO | CALIFORNIA | Participating Provider | 370663567 | 0 | 0 | $0 | $0 | 27 | $45,116 | $40,285 | |||
| Subtotal | 1 | 4 | $25,445 | $21,719 | 41 | $92,473 | $83,925 | ||||||
| BARNES JEWISH EXTENDED CARE | SAINT LOUIS | MISSOURI | Participating Provider | 237309937 | 1 | 33 | $93,108 | $92,674 | 0 | $0 | $0 | ||
| Subtotal | 1 | 33 | $93,108 | $92,674 | 0 | $0 | $0 | ||||||
| SSM HEALTH ST JOSEPH HOSPITAL ST CHARLES | CHICAGO | ILLINOIS | Participating Provider | 431343281 | 3 | 7 | $35,007 | $24,577 | 9 | $13,252 | $9,641 | ||
| SAINT LOUIS | MISSOURI | Participating Provider | 431343281 | 0 | 0 | $0 | $0 | 3 | $39,466 | $32,523 | |||
| Subtotal | 3 | 7 | $35,007 | $24,577 | 12 | $52,718 | $42,164 | ||||||
| ST LOUIS JC VAMC | CLEVELAND | OHIO | Participating Provider | 430687806 | 0 | 0 | $0 | $0 | 31 | $74,281 | $62,564 | ||
| Subtotal | 0 | 0 | $0 | $0 | 31 | $74,281 | $62,564 | ||||||
| MANCHESTER AMB SURG CTR | SAINT LOUIS | MISSOURI | Participating Provider | 205953313 | 0 | 0 | $0 | $0 | 7 | $73,279 | $61,429 | ||
| Subtotal | 0 | 0 | $0 | $0 | 7 | $73,279 | $61,429 | ||||||
| MERCY OUTPATIENT SURGERY CENTER ST LOUIS | BALLWIN | MISSOURI | Participating Provider | 430653493 | 0 | 0 | $0 | $0 | 26 | $64,235 | $58,184 | ||
| Subtotal | 0 | 0 | $0 | $0 | 26 | $64,235 | $58,184 | ||||||
| SSM HEALTH ST CLARE HOSPITAL | SAINT LOUIS | MISSOURI | Participating Provider | 431343281 | 1 | 2 | $9,620 | $7,935 | 8 | $50,169 | $39,343 | ||
| Subtotal | 1 | 2 | $9,620 | $7,935 | 8 | $50,169 | $39,343 | ||||||
| MERCY URGENT CARE | CHICAGO | ILLINOIS | Participating Provider | 812782453 | 0 | 0 | $0 | $0 | 249 | $54,887 | $47,040 | ||
| Subtotal | 0 | 0 | $0 | $0 | 249 | $54,887 | $47,040 | ||||||
| ST SOPHIA HEALTH & REHABILITATION CENTER | SAINT LOUIS | MISSOURI | Participating Provider | 474646042 | 1 | 34 | $43,923 | $43,564 | 0 | $0 | $0 | ||
| Subtotal | 1 | 34 | $43,923 | $43,564 | 0 | $0 | $0 | ||||||
| UCSF MEDICAL CENTER | LOS ANGELES | CALIFORNIA | Participating Provider | 943281657 | 0 | 0 | $0 | $0 | 1 | $46,927 | $43,389 | ||
| Subtotal | 0 | 0 | $0 | $0 | 1 | $46,927 | $43,389 | ||||||
| SSM HLTH CARDINAL GLENNON CHILDRENS HOSP | CHICAGO | ILLINOIS | Participating Provider | 430738490 | 0 | 0 | $0 | $0 | 18 | $47,262 | $40,457 | ||
| Subtotal | 0 | 0 | $0 | $0 | 18 | $47,262 | $40,457 | ||||||
| ANDERSON HOSPITAL | EDWARDSVILLE | ILLINOIS | Participating Provider | 370662561 | 2 | 12 | $34,453 | $28,674 | 7 | $8,098 | $6,892 | ||
| Subtotal | 2 | 12 | $34,453 | $28,674 | 7 | $8,098 | $6,892 | ||||||
| SSM ST CLARE SURGICAL CENTER | SAINT LOUIS | MISSOURI | Participating Provider | 261439695 | 0 | 0 | $0 | $0 | 11 | $44,737 | $31,767 | ||
| Subtotal | 0 | 0 | $0 | $0 | 11 | $44,737 | $31,767 | ||||||
| ST LUKES HOSPITAL SURREY PLACE | SALT LAKE CITY | UTAH | Participating Provider | 430652680 | 1 | 18 | $31,249 | $29,360 | 0 | $0 | $0 | ||
| Subtotal | 1 | 18 | $31,249 | $29,360 | 0 | $0 | $0 | ||||||
| Subtotal | 247 | 1,109 | $8,410,500 | $7,900,479 | 2,818 | $6,495,522 | $5,667,566 |
&C&"Tahoma,Bold"&20St. Louis Public Schools&18 Hospital & Outpatient Facility Provider Disruption Using Claims data 1/1/15 - 12/31/15 (paid thru 1/31/2016) &CThe above analysis is for illustrative purposes only. Please refer to contract and/or proposal for details. Final rates are determined by many variables - see Disclosures Page for further details.
USI - Confidential && Proprietary&RPage &P
Performance Guarantees
| St. Louis Public Schools | ||
| REQUIRED EXHIBITS - Performance Guarantees | ||
| Carrier Name: | ||
| Performance Standard | Fees at Risk | |
| Member Services | ||
| Answer Time | ||
| Average Hold Time | ||
| Abandonment Rate | ||
| Problem Resolution | ||
| Overall Satisfaction | ||
| Total | ||
| Claim Processing | ||
| Turnaround Time | ||
| Payment Accuracy | ||
| Procedural Accuracy | ||
| Total | ||
| Plan Implementation | ||
| ID Card Delivery | ||
| Forms Delivery | ||
| Total |
File details come from the government source that posted it. Updated .