COE_HCC_NO_PHI_100000_Current.pdf
PDF 27 KB Posted
- Attached to
- Pharmacy Benefits 2025-2026
- Solicitation number
- 2025-011
- Issued by
- Hidalgo County, Texas
About this file
This document is a medical claims cost report for the City of Edinburg, Texas, covering a high-cost healthcare claims analysis for the period of October 2024 to April 2025. The report details medical and pharmacy paid claims for five individuals enrolled in a PPO benefit package, with a total paid amount of $863,043.85, broken down into $742,100.78 in medical paid claims and $120,943.07 in pharmacy paid claims.
The report provides granular information about each covered individual, including their relationship to the subscriber (subscriber, spouse, dependent child), age/gender band, enrollment status, benefit package type, and primary diagnosis. The claims range from medical conditions such as diffuse non-Hodgkin's lymphoma and disorders related to short gestation to follow-up examinations and fracture treatments. One claim is noted as COVID-19 confirmed. The document is generated by Blue Insight and appears to be part of a high-cost claims analysis to evaluate healthcare spending for the City of Edinburg's health benefits program.
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Text version
COE HCC NO PHI 100000_Current
Run Date: 6/5/2025
Metrics:
Database:
High Cost
Paid Month:
Service
Member Relationship DescriptionMember Age/Gender BandCurrently Enrolled IndicatorBenefit PackageMedical Paid Pharmacy PaidPaid Primary Diagnosis COVID-19 Confirmed
Subscriber Male 40-49 Yes PPO ACTIVE 306,281.93 10,205.67 316,487.60 C83 - Diffuse non-Hodgkin's lymphoma
No
Dependent Child Male <1-19 No PPO ACTIVE 169,745.73 0.00 169,745.73 P07 - Disorders related to short gestation and low birth weight, not elsewhere classified
No
Spouse Male 40-49 Yes PPO ACTIVE 142,581.99 1,352.03 143,934.02 Z51 - Other medical care Yes
Subscriber Female 50-59 YesPPO RETIREE PRE 65 13,142.54 109,385.37 122,527.91 Z08 - Follow-up examination after treatment for malignant neoplasms
No
Dependent Child Female <1-19 Yes PPO ACTIVE 110,348.59 0.00 110,348.59 S42 - Fracture of shoulder and upper arm
No
Query Totals: 5 742,100.78 120,943.07 863,043.85
Report Totals: 5 742,100.78 120,943.07 863,043.85
(Paid)
(CITY OF EDINBURG 000243483: ALL)
($100,000)
(Oct 2024 - Apr 2025)
(FACILITY INPATIENT, FACILITY OUTPATIENT, PROFESSIONAL, PHARMACY)
COVID-19 Confirmed
File details come from the government source that posted it. Updated .