ESBD_486865_1770151667310_Provider Reimbursement.xlsx

This file is a provider reimbursement submission form for the Texas A&M University System's self-insured employee group medical plan administration contract. The document consists of five forms designed to collect comprehensive information from proposing vendors regarding their provider network capabilities, reimbursement methodologies, and claims repricing processes across multiple Texas service areas including Bryan/College Station, Corpus Christi, Houston, Dallas/Fort Worth, San Antonio, and numerous other regional locations. Form 1 requests detailed provider network data organized by service area, including current and projected numbers of primary care physicians (family/general practice, internal medicine, pediatrics, and OB/Gyn) and specialists (cardiology, orthopedic, oncology, dermatology, allergy, radiology, and psychiatry), as well as hospital bed inventory by type and membership enrollment information. Forms 2 through 4 address reimbursement arrangements, provider compensation structures (capitation, discounted fee-for-service, DRG, per diem models), specific CPT code allowable charges by geographic area, and physician fee schedule effective dates and changes.

Form 5 requires proposers to provide claims repricing analysis demonstrating how they would process and reimburse claims as of January 1, 2026, including claim numbers, line numbers, contracting allowable charges, and provider contracting status codes that differentiate between contracted network providers, non-network providers with alternative contracting arrangements allowing discounted reimbursement, and providers with no established contracting status. The submission establishes a standardized evaluation framework across all designated Texas A&M University System service areas to assess vendor capability to manage provider networks, implement varied reimbursement methodologies, and process claims consistent with the plan's contractual requirements. All data points throughout the forms are structured to populate with zero values, indicating this is a template requiring vendors to input their specific network composition, fee schedules, and repricing capabilities.