Attachment 005 - Data Requirements and Misc Notes.xlsx

XLSX spreadsheet 23 KB Posted Sep 2, 2025

Attached to: Accident and Sickness Program for Exchanges (ASPE) Health Benefits Plan Program Federal contract opportunity
Solicitation number: 19AQMM25R0153
Issued by: Department of State Office of Acquisition Management

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Written by GovTribe AI · Sep 3, 2025

The file is an Excel spreadsheet titled "Attachment 005 - Data Requirements and Misc Notes.xlsx" containing detailed historical data requirements for the Accident and Sickeness Program for Exchanges (ASPE) Health Benefits Plan Program. The spreadsheet captures comprehensive data across multiple categories including claims history, covered persons, call center operations, and medical support, with granular tracking of international and U.S. claims, services, and expenditures from 2019-2024.

The data collection template requires reporting on key metrics such as pharmacy service claims, medical evacuation services, repatriation of remains, provider network access claims, guarantee of payment processes, mental health services, medical crisis management support, and participant demographics. The document breaks down reporting requirements into specific subcategories like claim volumes by jurisdiction, types of claims, denied claims, mental health counseling services, inpatient and outpatient care, emergency room visits, and medical escort services, with separate columns for international and U.S. data and corresponding expenditure tracking.

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Other files for this federal contract opportunity

Other files attached to Accident and Sickness Program for Exchanges (ASPE) Health Benefits Plan Program, newest first.
File	Type	Posted
19AQMM25R0153 Amendment 0001.pdf	PDF	Sep 3, 2025
19AQMM25R0153.pdf	PDF	Sep 3, 2025
Attachment 004 - Past Performance Questionnaire.docx	DOCX document	Sep 2, 2025
Attachment 003 - Quality Assurance Surveillance Plan (QASP).docx	DOCX document	Sep 2, 2025
Attachment 001 - Statement of Work (SOW).docx	DOCX document	Sep 2, 2025
Attachment 002 - Pricing Table.xlsx	XLSX spreadsheet	Sep 2, 2025
19AQMM25R0153.pdf	PDF	Sep 2, 2025

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Sheet1

A	GENERAL CLAIMS HISTORIC DATA	RESPONSE NARRATIVE (If needed)	CY 2019	CY2020	CY2021	CY2022	CY2023	CY2024
A1	Number of International and U.S. pharmacy service claims
A2	Medical evacuation services including medical escort worldwide
A3	Repatriation of mortal remains (Total number for CY)
A4	International and U.S. provider network access option claims
A4.1	International provider network access option claims
A4.2	U.S. provider network access option claims
A5	Total number of Guarantee of Payment (GOP) processes to providers in the U.S. and International
A5.1	GOP processes U.S.
A5.2	GOP processes International by Country
A6	Claims history reporting by ECA exchange program office
A7	What was the total medical claims spend by ASPE FY 2022-2023
A7.1	Volumes of claims by jurisdiction (List Country and number of claims per country)
A7.2	Types of claims (By type)	If needed, please add claims by type itemized count as attachment.
A7.3	High-frequency claim jurisdictions (List claims by type for top 5 types of claims)	If needed, please add claims by top 5 types itemized count as attachment.
A7.4	Total number of coordination of benefits between primary or secondary insurance
A8	Total Claims Denied
A8.1	Claims denied by type	If needed, please add claims by type itemized count as attachment.
A8.1.1	Total number of International claims denied
A8.1.2	Total number of U.S. claims denied
A9	Total number of claims exceeeding $100k ASPE cap
A9.1	Total number of International participants exceeeding $100k ASPE cap
A9.2	Total number of U.S. participants exceeeding $100k ASPE cap

B	COVERED PERSONS HISTORIC DATA
B1	Average number of ASPE members per month.	Data is available for 2022-2023 Academic Year at:

https://opendoorsdata.org/data/international-students/all-places-of-origin/ B2.1 Domiciled in the U.S. traveling abroad (U.S.) Data is available for 2022-2023 Academic Year at:

https://opendoorsdata.org/data/international-students/all-places-of-origin/ B2.2 Domiciled outside the U.S. traveling to the US (International) Data is available for 2022-2023 Academic Year at:

https://opendoorsdata.org/data/international-students/all-places-of-origin/ B3 Number of students per host country (Number of participants by Host Country- i.e. U.S. Participants in X Host Country) Data is available for 2022-2023 Academic Year at:

https://opendoorsdata.org/data/international-students/all-places-of-origin/ B4 Number of students per originating country Data is available for 2022-2023 Academic Year at:

https://opendoorsdata.org/data/international-students/all-places-of-origin/

C	CALL CENTER HISTORIC DATA	RESPONSE NARRATIVE (If needed)	CY 2019	CY2020	CY2021	CY2022	CY2023	CY2023
C1	Total Number of phone calls: 24-hour crisis line and 24-hour call center, medical consultation, and assistance services
C2	Total number of mental health telemedicine cases:
C2.1	# of International 24-hour emergent mental health counseling services
C2.1.1	Total Expenditures for International Claims ($)
C2.2	# of U.S. 24-hour emergent mental health counseling services
C2.2.1	Total Expenditures for U.S. Claims ($)
C3	Mental health care solutions total (Count by type)
C3.1	Crisis support (First 2 calls: Crisis Support and Intake)
C3.1.1	# of International
C3.1.1.1	Total Expenditures for International Claims ($)
C3.1.2	# of U.S.
C3.1.2.1	Total Expenditures for U.S. Claims ($)
C3.2	Telehealth (ongoing care)
C3.2.1	# of International
C3.2.1.1	Total Expenditures for International Claims ($)
C3.2.2	# of U.S.
C3.2.2.1	Total Expenditures for U.S. Claims ($)
C3.3	Inpatient Mental Health Care (Count)
C3.3.1	# of International
C3.3.1.1	Total Expenditures for International Claims ($)
C3.3.2	# of U.S.
Cs.3.2.1	Total Expenditures for U.S. Claims ($)
C3.3.1	Average length of Inpatient Mental Health Stay (Days)
C3.3.1.1	# of International Average length of Inpatient Mental Health Stay (Days)
C3.3.1.1.1	Total Expenditures for International Claims ($)
C3.3.1.2	# of U.S. Average length of Inpatient Mental Health Stay (Days)
C3.3.1.2.1	Total Expenditures for U.S. Claims ($)

D	MEDICAL SUPPORT HISTORIC DATA	RESPONSE NARRATIVE (If needed)	CY 2019	CY2020	CY2021	CY2022	CY2023	CY2024
D1	Total International and U.S. 24-hour medical crisis management support cases (Count)
D1.1	How many were inpatient
D1.1.1	Average length of Inpatient Stay (Days)
D1.1.1.1	Total Expenditures for International Claims ($)
D1.1.1.1.1	Total Expenditures for U.S. Claims ($)
D1.2	How many were outpatient
D1.2.1	# of International
D1.2.1.1	Total Expenditures for International Claims ($)
D1.2.2	# of U.S.
D1.2.2.1	Total Expenditures for U.S. Claims ($)
D1.3	How many were emergency room
D1.3.1	# of International
D1.3.1.1	Total Expenditures for International Claims ($)
D1.3.2	# of U.S.
D1.3.2.1	Total Expenditures for U.S. Claims ($)
D1.4	How many were urgent care clinic
D1.4.1	# of International
D1.4.1.1	Total Expenditures for International Claims ($)
D1.4.2	# of U.S.
D1.4.2.1	Total Expenditures for U.S. Claims ($)
D2	Number of pharmacy claims (Count)
D2.1	International claims (Count by country)	If needed, please add by country claims itemized count as attachment.
D.2.1.1	Total Expenditures for International Claims ($)
D2.2	U.S. claims (by medicine type)	If needed, please add by claims by medicine type itemized count as attachment.
D2.2.1	Total Expenditures for U.S. Claims ($)
D3	Total number of Medevacs (all types) requested typically per month (Average per month Count)
D3.1	Non-Medical Escort (Count)
D3.1.1	Total Expenditures for Non-Medical Escort ($)
D3.1.1.1	# of International
D3.1.1.2	Total Expenditures for International Claims ($)
D3.1.1.3	# of U.S.
D3.1.2.4	Total Expenditures for U.S. Claims ($)
D3.2	Medical Escort (Count)
D3.2.1	Total Expenditures for Medical Escort ($)
D3.2.1.1	# of International
D3.2.1.2	Total Expenditures for International Claims ($)
D3.2.1.3	# of U.S.
D3.2.1.4	Total Expenditures for U.S. Claims ($)
D3.3	Air Medical Flight (Count)
D3.3.1	Total Expenditures for Air Medical Flight ($)
D3.3.1.1	# of International
D3.3.1.2	Total Expenditures for International Claims ($)
D3.3.1.3	# of U.S.
D3.3.1.4	Total Expenditures for U.S. Claims ($)

File details come from the government source that posted it. Updated Sep 3, 2025.