Attachment C _ FFS Claims Data Layout.xlsx

This file is a claims data layout specification for the City of Houston's Third Party Administrator (TPA) and chronic disease management services contract. The document provides the technical framework and data structure requirements that bidders must understand to process and manage the City's self-funded medical benefit plan claims. The claims data layout outlines the specific fields, formats, and data elements that vendors must be capable of receiving, processing, and reporting on, including patient demographics, claim amounts, service dates, provider information, and diagnostic codes. This specification is essential for vendors to demonstrate their technical capability to integrate with the City's existing systems and processes claims efficiently for City employees and their dependents under the five-year initial contract term with two optional one-year renewal periods.

The claims data layout serves as a technical requirement document rather than a pricing or budgetary document, focusing on the operational and systems integration capabilities required from qualified TPA vendors. Bidders must confirm their systems can accommodate the specified data formats and processing requirements outlined in the attachment to be considered responsive to the City's proposal solicitation. Understanding and meeting these technical specifications is a fundamental qualification criterion for any vendor seeking to provide TPA and chronic disease management services to the City of Houston.