Exhibit 18 - Cal Yrs 2023 _ 2024 City of Miami CIGNA FIXED Charges Report - PRR.xlsx

XLSX spreadsheet 65 KB Posted

Attached to
RFP No. 2130386 - Employee Health Benefits Plan
Solicitation number
RFP No. 2130386
Issued by
Florida

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Written by GovTribe AI ·

This document is a monthly healthcare experience and fixed charges report for the City of Miami's health benefits plan, covering calendar years 2023 and 2024. The report details healthcare claims and associated fixed charges for multiple benefit options, including Network Open Access POS, Standalone Network POS, Out of Area Plans, and Open Access Plans. The total claims for 2023 were $41,354,103, with 52,681 total members, and for 2024 (partial year data) were $46,486,255, with 53,080 total members. The City of Miami utilizes a self-funded (ASO) healthcare model with retrospective experience rating.

The healthcare plan includes various fixed charges and administrative caps, such as Collaborative Accountable Care, Mental Health Cap, Medical Oncology Treatment Fees, and Radiology Caps. Fixed charges for 2023 totaled $2,931,908, with significant allocations to Mental Health Cap ($1,944,989) and Medsolutions Radiology Cap ($637,239). The 2024 fixed charges were $2,482,716, showing a slight reduction. The report provides detailed monthly breakdowns of claims by benefit option, in-network and out-of-network expenses, and drug-related costs, offering comprehensive insight into the City of Miami's healthcare spending and utilization.

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Other files

File Type Posted
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Questionnaire No. 2 - Stop Loss Insurance.pdf PDF
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Exhibit 52a - Cal Yr 2022 City of Miami CIGNA Pooled Stop Loss High Claims Greater than 50K Experience De-ID.xlsx XLSX spreadsheet
Questionnaire No. 7 - Flexible Spending Accounts.pdf PDF
Exhibit 06c - Cal Yr 2025 City of Miami CIGNA Dental PPO Certificate Riders and Coverage for other states ETALLD25B Plan 3202272 HC-IMP35.pdf PDF
Exhibit 47 - Cal Yr 2023 City of Miami CIGNA Dental Exp.xlsx XLSX spreadsheet
Questionnaire No. 5 - Group Benefit Vision Plan.pdf PDF
Exhibit 29 - Cal Yr 2025 City of Miami CIGNA OAP No Rx PlanMedical Benefits - Summary Benefits Coverage POST 65.pdf PDF
Exhibit 25 - Cal Yr 2025 City of Miami Cobra Monthly Premiums.pdf PDF
Exhibit 03 - City of Miami AFSCME 1907 General Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 45 - Cal Yr 2024 City of Miami EAP - EAP Utilization.pptx PPTX presentation
Exhibit 05 - Cal Yr 2024 City of Miami CIGNA Dental HMO Plan Document.pdf PDF
2130386 - Sample PSA.pdf PDF
Exhibit 38 - Cal Yr 2023 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Exhibit 44 - Cal Yrs 2025 _ 2026 EAP Renewal Letter.pdf PDF
Exhibit 74 - Cal Yr 2023 City of Miami ASO Fixed Charges and Fees Per Product Type Monthly Healthcare Detail Experience.xlsx XLSX spreadsheet
Exhibit 37 - Cal Yr 2022 City of Miami Stop Loss - Greater than 50K High Claimant Report De-ID Dx.xlsx XLSX spreadsheet
Questionnaire No. 8 - COBRA.pdf PDF
Exhibit 55 - Cal Yr 2025 as of Apr EAP Network Analysis Report Access 118974.pdf PDF
Exhibit 57c - Cal Yr 2025 YTD as of Jul - City of Miami CIGNA Pharmacy RX Dispensed Report.xlsx XLSX spreadsheet
Exhibit 08 - Cal Yr 2024 City of Miami CIGNA EGWP Medicare Formulary.pdf PDF
Exhibit 62 - Cal Yr 2025 City of Miami CIGNA FSA Healthcare - Summary Plan Document.pdf PDF
Exhibit 16 - Cal Yr 2024 City of Miami CIGNA Open Access Plan (OAP) Medicare No Rx - Comp EEs Plan 80 Percent Ded 500 Max Out of Pocket 2K ASO66.pdf PDF
Exhibit 49 - Cal Yr 2023 City of Miami CIGNA Vision Plans Claim Summary Report.pdf PDF
Exhibit 54b - Cal Yr 2025 City of Miami Stop CIGNA ISL and ASL Coverage Information Amendment Plan 3202272 CSL-SCH(10-15).pdf PDF
Exhibit 34 - Cal Yr 2025 City of Miami CIGNA Dental HMO Summary with Patient Charge Schedule.pdf PDF
Exhibit 42 - Cal Yr 2025 City of Miami CIGNA TC19 Disruption Report - Total Records Total Claimants Total Eligible Charges Summary.xlsx XLSX spreadsheet
Exhibit 61 - Cal Yr 2025 City of Miami CIGNA FSA Dependent Care - Summary Plan Document.pdf PDF
Exhibit 41a - Cal Yr 2025 City of Miami CIGNA Medical - Disruption Detail with Provider TIN - Option 1 - OAP-OA001 RITM9284277_TC19.xlsx XLSX spreadsheet
Exhibit 59 - City of Miami CIGNA Medical - Professional Services Agreement AMENDMENT NO 1 May 6 2021 ASO Agreement with Fees.pdf PDF
Exhibit 02 - City of Miami AFSCME 871 Sanitation Employees Union Contract Oct 1 2023 - Sep 30 2026.pdf PDF
Exhibit 15 - City of Miami Cal Yr 2024 CIGNA Medical - Comp EEs Plan 70 Percent Ded 300 Max Out of Pocket 1K ASO64.pdf PDF
Exhibit 30a - Cal Yr 2025 City of MIami CIGNA VIS Vision Benefit imbedded in Medical Plan Document ASO71.pdf PDF
Exhibit 22 - Cal Yr 2025 City of Miami CIGNA Sum Ben Cov Comp EEs No Rx- Out Of Area Plan - Plan 70 Pct Ded 300 Max Out of Pocket 1K ASO67.pdf PDF
Attachment A - City of Miami Living Wage Ordinance.pdf PDF
Exhibit 19 - Cal Yr 2025 City of Miami CIGNA Medical - SBC Comp Ded 300 Max Out of Pocket 1K.pdf PDF
Exhibit 63 - Aug 2024 to Jul 2025 City of Miami CIGNA Claims by Benefits and ASO Fees Monthlty Healthcare Experience by Ben Option Rlg 12.xlsx XLSX spreadsheet
Exhibit 17c - Cal Yr 2025 City of Miami CIGNA Healthcare Massachusetts Rider for OAP Plans HC-RDR1.pdf PDF
Exhibit 54a - Cal Yr 2025 City of Miami CIGNA Medical - Administrative Services Only ASO And Stop Loss Fees Schedule.pdf PDF
Exhibit 05c - Cal Yr 2025 City of Miami CIGNA Dental HMO Certificate Riders and Coverage for 7 States ETALLD25A Plan 3202272 HC-ETRDR.pdf PDF
Exhibit 06d - Cal Yr 2025 City of Miami CIGNA Dental PPO Territorial Legislation - 23 States ETALLD25B.pdf PDF
Exhibit 31 - Cal Yr 2024 City of Miami CIGNA Lag Report Incurred Date included - Monthly Healthcare Experience by Acct Rolling 12-1.xlsx XLSX spreadsheet
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CITY OF MIAMI
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
January 2023 thru December 2023
Funding Type : SELF-FUNDED (ASO)
Rating Type : RETROSPECTIVE EXPERIENCE RATED
Reported Premium: ASO Fees
Reported Claims: All Claims
Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.
YTD/MONTHBENEFIT OPTIONIN NETWORKOUT OF NETWORKDRUGTOTAL CLAIMSTOTAL SUBSTOTAL MBRS
Jan-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,316,536$26,921$652,034$2,995,4922,0644,221
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$41,709$4,357$0$46,066176205
OOA-OUT OF AREA PLAN($15)$0$0($15)11
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$120$0$0$12055
Jan-2023 Total$2,358,349$31,278$652,034$3,041,6622,2464,432
Feb-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,613,225$14,619$780,033$3,407,8772,0484,182
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$57,967$4,287$0$62,254175204
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$8$0$0$855
Feb-2023 Total$2,671,200$18,906$780,033$3,470,1392,2294,392
Mar-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,895,120$30,662$662,250$3,588,0332,0484,177
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$91,136$1,442$0$92,579174203
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$74$0$0$7455
Mar-2023 Total$2,986,331$32,104$662,250$3,680,6862,2284,386
Apr-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,068,802$26,179$786,682$2,881,6632,0434,172
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($2,638)$1,794$0($845)174204
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$513$0$0$51355
Apr-2023 Total$2,066,677$27,973$786,682$2,881,3312,2234,382
May-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,899,734$29,629$800,093$3,729,4562,0324,154
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($37,173)$2,494$0($34,679)174204
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$901$0$0$90144
May-2023 Total$2,863,462$32,122$800,093$3,695,6782,2114,363
Jun-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,480,289$20,943$636,562$3,137,7952,0374,170
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$28,575$7,959$0$36,534171200
OOA-OUT OF AREA PLAN$81$0$0$8111
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$391$0$0$39144
Jun-2023 Total$2,509,336$28,903$636,562$3,174,8012,2134,375
Jul-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,417,860$55,830$994,699$3,468,3902,0334,166
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$114,890$2,768$0$117,658170199
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$222$0$0$22244
Jul-2023 Total$2,532,972$58,599$994,699$3,586,2702,2084,370
Aug-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,826,523$34,299$971,942$3,832,7632,0394,182
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$55,249$1,458$86$56,794170199
OOA-OUT OF AREA PLAN$0$0$0$011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$28$0$0$2844
Aug-2023 Total$2,881,800$35,757$972,028$3,889,5852,2144,386
Sep-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,178,503$19,657$1,033,588$3,231,7482,0404,193
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$63,009$4,452$0$67,462170199
OOA-OUT OF AREA PLAN($6)$0$0($6)11
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$233$0$0$23344
Sep-2023 Total$2,241,738$24,110$1,033,588$3,299,4362,2154,397
Oct-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,556,654$33,377$1,034,432$3,624,4632,0404,195
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$66,717$106,960$0$173,677169198
OOA-OUT OF AREA PLAN$129$0$99$22811
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$637$0$0$63744
Oct-2023 Total$2,624,137$140,337$1,034,531$3,799,0052,2144,398
Nov-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,226,296$9,562$878,609$3,114,4682,0454,195
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$58,254$29,850$0$88,104168197
OOA-OUT OF AREA PLAN$61$0$9$7011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$170$0$0$17044
Nov-2023 Total$2,284,781$39,412$878,618$3,202,8122,2184,397
Dec-23NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,520,873$27,263$993,713$3,541,8492,0494,201
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$80,105$10,121$0$90,226168197
OOA-OUT OF AREA PLAN$50$0$0$5011
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$571$0$0$57144
Dec-2023 Total$2,601,600$37,384$993,713$3,632,6972,2224,403
BENEFIT OPTION TotalsNPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$617,801$177,942$86$795,8302,0592,409
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$30,000,414$328,942$10,224,639$40,553,99624,51850,208
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$3,868$0$0$3,8685252
OOA-OUT OF AREA PLAN$301$0$108$4091212
Grand Total$30,622,385$506,884$10,224,834$41,354,10326,64152,681

&G &7This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law. ADVICE Reporting System &8Page &P of &N Date: 7/30/2025

CITY OF MIAMI
MONTHLY HEALTHCARE DETAIL EXPERIENCE REPORT
January 2024 thru December 2024
EXHIBIT 18
Funding Type : SELF-FUNDED (ASO)
Rating Type : RETROSPECTIVE EXPERIENCE RATED
Reported Premium: ASO Fees
Reported Claims: All Claims
Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.
YTD/MONTHBENEFIT OPTIONIN NETWORKOUT OF NETWORKDRUGTOTAL CLAIMSTOTAL SUBSTOTAL MBRS
Jan-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$1,358,990$36,684$224,508$1,620,18200
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$26,003$3,018$0$29,02100
OAPAE-OAP PLAN ALL EMPLOYEES$842,739$120$714,301$1,557,1602,0724,236
OAPCE-OAP PLAN COMP EES$0$0$0$011
OAPCX-OAP COMP EES NO RX$0$0$0$044
OAPNX-OAP PLAN NO RX$5,679$0$0$5,679168196
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$362$0$0$36200
Jan-2024 Total$2,233,772$39,822$938,809$3,212,4032,2454,437
Feb-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$539,116$8,058($679)$546,49600
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($18,659)$336$0($18,322)00
OAPAE-OAP PLAN ALL EMPLOYEES$2,534,636$4,246$740,653$3,279,5342,0684,229
OAPCE-OAP PLAN COMP EES$35$0$0$3511
OAPCX-OAP COMP EES NO RX$733$0$0$73344
OAPNX-OAP PLAN NO RX$71,369$3,137$0$74,506167195
OOA-OUT OF AREA PLAN$5$0$0$500
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$1,686$0$0$1,68600
Feb-2024 Total$3,128,921$15,778$739,974$3,884,6732,2404,429
Mar-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$383,142$5,866($416)$388,59300
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($31,892)$179$0($31,713)00
OAPAE-OAP PLAN ALL EMPLOYEES$2,693,956$23,064$1,231,565$3,948,5862,0724,238
OAPCE-OAP PLAN COMP EES$35$0$0$3511
OAPCX-OAP COMP EES NO RX$147$0$0$14744
OAPNX-OAP PLAN NO RX$44,409$4,678$0$49,087164192
OOA-OUT OF AREA PLAN($5)$0$0($5)00
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$32$0$0$3200
Mar-2024 Total$3,089,825$33,787$1,231,149$4,354,7622,2414,435
Apr-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$297,284$813$49$298,14600
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$1,079$400$0$1,47900
OAPAE-OAP PLAN ALL EMPLOYEES$2,959,101$20,850$1,057,420$4,037,3712,0714,246
OAPCE-OAP PLAN COMP EES$35$0$0$3511
OAPCX-OAP COMP EES NO RX$192$0$0$19244
OAPNX-OAP PLAN NO RX$43,808$11,494$0$55,302163191
Apr-2024 Total$3,301,499$33,558$1,057,469$4,392,5262,2394,442
May-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$31,058$368$0$31,42700
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($661)$50$0($611)00
OAPAE-OAP PLAN ALL EMPLOYEES$2,386,694$26,101$1,232,584$3,645,3792,0754,247
OAPCE-OAP PLAN COMP EES$422$0$38$46011
OAPCX-OAP COMP EES NO RX$478$94$0$57344
OAPNX-OAP PLAN NO RX$89,002$8,825$0$97,827163191
May-2024 Total$2,506,994$35,439$1,232,623$3,775,0552,2434,443
Jun-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$99,980$17$0$99,99700
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($189)$0$0($189)00
OAPAE-OAP PLAN ALL EMPLOYEES$2,771,540$47,694$1,090,030$3,909,2642,0634,225
OAPCE-OAP PLAN COMP EES$169$0$0$16911
OAPCX-OAP COMP EES NO RX$304$0$0$30444
OAPNX-OAP PLAN NO RX$86,451$9,646$0$96,096162190
Jun-2024 Total$2,958,255$57,356$1,090,030$4,105,6412,2304,420
Jul-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$50,032($7,555)$0$42,47700
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$290($9)$0$28200
OAPAE-OAP PLAN ALL EMPLOYEES$3,168,043$53,606$1,004,643$4,226,2912,0574,218
OAPCE-OAP PLAN COMP EES$682$22$0$70411
OAPCX-OAP COMP EES NO RX$666$27$0$69344
OAPNX-OAP PLAN NO RX$128,052$2,131$0$130,183161188
Jul-2024 Total$3,347,766$48,221$1,004,643$4,400,6302,2234,411
Aug-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$3,372$58$381$3,81100
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($950)$59$0($891)00
OAPAE-OAP PLAN ALL EMPLOYEES$2,623,606$45,698$1,108,980$3,778,2852,0594,224
OAPCE-OAP PLAN COMP EES$64$0$0$6411
OAPCX-OAP COMP EES NO RX$311$38$0$34944
OAPNX-OAP PLAN NO RX$190,529$2,268$0$192,797160187
Aug-2024 Total$2,816,933$48,122$1,109,361$3,974,4162,2244,416
Sep-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$39,434$188$2,514$42,13500
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$289$24$0$31300
OAPAE-OAP PLAN ALL EMPLOYEES$2,118,686$30,719$1,105,990$3,255,3952,0554,216
OAPCE-OAP PLAN COMP EES$84$0$0$8411
OAPCX-OAP COMP EES NO RX$310$99$0$41044
OAPNX-OAP PLAN NO RX$5,439$1,797$0$7,236159186
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$31$0$0$3100
Sep-2024 Total$2,164,274$32,827$1,108,504$3,305,6052,2194,407
Oct-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$154,640($39)$4,360$158,96100
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($29)$41$0$1200
OAPAE-OAP PLAN ALL EMPLOYEES$2,121,299$91,163$1,207,024$3,419,4862,0594,224
OAPCE-OAP PLAN COMP EES$177$0$26$20311
OAPCX-OAP COMP EES NO RX$1,823$0$0$1,82344
OAPNX-OAP PLAN NO RX$73,183$2,884$0$76,067159186
Oct-2024 Total$2,351,093$94,048$1,211,410$3,656,5522,2234,415
Nov-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)($33,565)$205$0($33,360)00
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$38$25$0$6400
OAPAE-OAP PLAN ALL EMPLOYEES$1,801,968$13,443$625,510$2,440,9222,0624,225
OAPCE-OAP PLAN COMP EES$118$0$23$14111
OAPCX-OAP COMP EES NO RX$342$2$0$34444
OAPNX-OAP PLAN NO RX$50,754$832$0$51,586159186
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$40$0$0$4000
Nov-2024 Total$1,819,696$14,507$625,533$2,459,7352,2264,416
Dec-24NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)($65)($7,914)$0($7,980)00
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RX$15$1,484$0$1,49900
OAPAE-OAP PLAN ALL EMPLOYEES$3,187,894$52,433$1,564,321$4,804,6482,0594,218
OAPCE-OAP PLAN COMP EES$288$0$0$28811
OAPCX-OAP COMP EES NO RX$345$24$0$36944
OAPNX-OAP PLAN NO RX$161,285$4,148$0$165,433159186
Dec-2024 Total$3,349,761$50,175$1,564,321$4,964,2572,2234,409
BENEFIT OPTION TotalsNPOS2-STANDALONE NETWORK POS PLAN COPY NO RX($24,664)$5,608$0($19,056)00
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)$2,923,419$36,749$230,717$3,190,88500
OAPAE-OAP PLAN ALL EMPLOYEES$29,210,162$409,137$12,683,021$42,302,32124,77250,746
OAPCE-OAP PLAN COMP EES$2,110$22$87$2,2181212
OAPCX-OAP COMP EES NO RX$5,652$284$0$5,9364848
OAPNX-OAP PLAN NO RX$949,960$51,840$0$1,001,8001,9442,274
OOA2-STANDALONE OUT OF AREA PLAN COPY NO RX$2,150$0$0$2,15000
OOA-OUT OF AREA PLAN$0$0$0$000
Grand Total$33,068,789$503,641$12,913,825$46,486,25526,77653,080

&7This report contains proprietary and/or confidential information. Disclosure is strictly prohibited except to the extent required by law. ADVICE Reporting System &8Page &P of &N

2023 Fixed Charges

CITY OF MIAMI
FIXED CHARGES - INTERNAL USE ONLY
January 2023 thru December 2023
Reported Claims: FIXED CHARGES
Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.
YTD/MONTHFIXED CHARGES/CAP TYPEFIXED CHARGES
Jan-23AGNOSTIC ADMIN CAP$2,854
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
EMBARC BENEFIT PROTECTION$4,337
MEDSOLUTIONS RADIOLOGY CAP$52,264
MENTAL HEALTH CAP$163,473
MSI DIAGNOSTIC CARDIOLOGY MANAGEMENT$832
MSI MUSCULOSKELETAL PRECERT$1,709
RADIATION THERAPY CASE FEE$885
SHARED SAVINGS CAC$22
Jan-2023 Total$226,377
Feb-23AGNOSTIC ADMIN CAP$2,953
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$27,806
EMBARC BENEFIT PROTECTION$4,375
HOSPITAL P4P$1,769
HOSPITAL P4P OUTPATIENT$1,507
MEDICAL ONCOLOGY TREATMENT FEE$1,050
MEDSOLUTIONS RADIOLOGY CAP$52,340
MENTAL HEALTH CAP$163,708
MSI DIAGNOSTIC CARDIOLOGY MANAGEMENT($2)
MSI MUSCULOSKELETAL PRECERT($4)
RADIATION THERAPY CASE FEE$912
Feb-2023 Total$256,416
Mar-23AGNOSTIC ADMIN CAP$2,931
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$13,822
EMBARC BENEFIT PROTECTION($26,806)
HOSPITAL P4P$6,902
HOSPITAL P4P OUTPATIENT$8,501
MEDSOLUTIONS RADIOLOGY CAP$51,352
MENTAL HEALTH CAP$160,675
MSI MUSCULOSKELETAL PRECERT$3,519
Mar-2023 Total$220,898
Apr-23AGNOSTIC ADMIN CAP$2,924
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$13,935
EMBARC BENEFIT PROTECTION$4,327
MEDSOLUTIONS RADIOLOGY CAP$51,791
MENTAL HEALTH CAP$162,042
MSI DIAGNOSTIC CARDIOLOGY MANAGEMENT($0)
MSI MUSCULOSKELETAL PRECERT$1,748
Apr-2023 Total$236,770
May-23AGNOSTIC ADMIN CAP$2,925
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$10,371
EMBARC BENEFIT PROTECTION$4,326
HOSPITAL P4P OUTPATIENT$1,540
MEDICAL ONCOLOGY TREATMENT FEE$2,100
MEDSOLUTIONS RADIOLOGY CAP$51,435
MENTAL HEALTH CAP$160,934
MSI MUSCULOSKELETAL PRECERT$1,748
RADIATION THERAPY CASE FEE$1,824
SHARED SAVINGS CAC$6
May-2023 Total$237,211
Jun-23AGNOSTIC ADMIN CAP$2,908
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,066
EMBARC BENEFIT PROTECTION$4,301
MEDICAL ONCOLOGY TREATMENT FEE$2,100
MEDSOLUTIONS RADIOLOGY CAP$51,649
MENTAL HEALTH CAP$161,599
MSI MUSCULOSKELETAL PRECERT$1,738
RADIATION THERAPY CASE FEE$912
SCC PERIODIC RECONCILIATION$53
Jun-2023 Total$239,327
Jul-23AGNOSTIC ADMIN CAP$2,920
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,484
EMBARC BENEFIT PROTECTION$4,317
HOSPITAL P4P OUTPATIENT$125
MEDSOLUTIONS RADIOLOGY CAP$51,648
MENTAL HEALTH CAP$161,595
MSI MUSCULOSKELETAL PRECERT$1,744
Jul-2023 Total$236,836
Aug-23AGNOSTIC ADMIN CAP$2,907
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,523
EMBARC BENEFIT PROTECTION$4,310
HOSPITAL P4P OUTPATIENT$385
MEDICAL ONCOLOGY TREATMENT FEE$1,050
MEDSOLUTIONS RADIOLOGY CAP$51,802
MENTAL HEALTH CAP$162,076
MSI MUSCULOSKELETAL PRECERT$1,742
SHARED SAVINGS CAC$66
Aug-2023 Total$238,864
Sep-23AGNOSTIC ADMIN CAP$2,923
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,469
EMBARC BENEFIT PROTECTION$4,317
EOC PERIODIC RECONCILIATION$104
MEDICAL ONCOLOGY TREATMENT FEE$1,050
MEDSOLUTIONS RADIOLOGY CAP$51,828
MENTAL HEALTH CAP$162,149
MSI MUSCULOSKELETAL PRECERT$1,746
RADIATION THERAPY CASE FEE$1,824
SCC PERIODIC RECONCILIATION$54,950
Sep-2023 Total$295,364
Oct-23AGNOSTIC ADMIN CAP$2,944
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,526
EMBARC BENEFIT PROTECTION$4,350
HOSPITAL P4P OUTPATIENT$32
MEDICAL ONCOLOGY TREATMENT FEE$2,100
MEDSOLUTIONS RADIOLOGY CAP$62,254
MENTAL HEALTH CAP$162,406
MSI MUSCULOSKELETAL PRECERT$1,756
RADIATION THERAPY CASE FEE$912
SHARED SAVINGS CAC$0
Oct-2023 Total$251,281
Nov-23AGNOSTIC ADMIN CAP$2,940
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,501
EMBARC BENEFIT PROTECTION$4,351
MEDICAL ONCOLOGY TREATMENT FEE$2,100
MEDSOLUTIONS RADIOLOGY CAP$54,357
MENTAL HEALTH CAP$161,926
MSI MUSCULOSKELETAL PRECERT$1,758
SHARED SAVINGS CAC$17
Nov-2023 Total$241,953
Dec-23AGNOSTIC ADMIN CAP$2,930
CHIRO$1
CHIROPRACTIC C/O ADMIN$1
COLLABORATIVE ACCOUNTABLE CARE$14,475
EMBARC BENEFIT PROTECTION$4,335
HOSPITAL P4P$606
HOSPITAL P4P OUTPATIENT$2,170
MEDSOLUTIONS RADIOLOGY CAP$54,519
MENTAL HEALTH CAP$162,406
MSI MUSCULOSKELETAL PRECERT$1,752
RADIATION THERAPY CASE FEE$912
SCC PERIODIC RECONCILIATION$6,502
Dec-2023 Total$250,611
FIXED CHARGES/CAP TYPE TotalsAGNOSTIC ADMIN CAP$35,058
CHIRO$11
CHIROPRACTIC C/O ADMIN$15
COLLABORATIVE ACCOUNTABLE CARE$166,979
EMBARC BENEFIT PROTECTION$20,842
EOC PERIODIC RECONCILIATION$104
HOSPITAL P4P$9,278
HOSPITAL P4P OUTPATIENT$14,260
MEDICAL ONCOLOGY TREATMENT FEE$11,550
MEDSOLUTIONS RADIOLOGY CAP$637,239
MENTAL HEALTH CAP$1,944,989
MSI DIAGNOSTIC CARDIOLOGY MANAGEMENT$830
MSI MUSCULOSKELETAL PRECERT$20,955
RADIATION THERAPY CASE FEE$8,181
SCC PERIODIC RECONCILIATION$61,505
SHARED SAVINGS CAC$111
Grand Total$2,931,908

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2024 Fixed Charges

CITY OF MIAMI
FIXED CHARGES - INTERNAL USE ONLY
January 2024 thru December 2024
Reported Claims: FIXED CHARGES
Note: Paid claim dollars include amounts deducted from your account and paid to vendors for cost containment services.
YTD/MONTHFIXED CHARGES/CAP TYPEFIXED CHARGES
Jan-24AGNOSTIC ADMIN CAP$2,922
COLLABORATIVE ACCOUNTABLE CARE$5,478
EMBARC BENEFIT PROTECTION$4,322
MEDICAL ONCOLOGY TREATMENT FEE$2,100
MEDSOLUTIONS RADIOLOGY CAP$37
MENTAL HEALTH CAP$138
MSI MUSCULOSKELETAL PRECERT$1,746
RADIATION THERAPY CASE FEE$912
Jan-2024 Total$17,656
Feb-24AGNOSTIC ADMIN CAP$3,145
COLLABORATIVE ACCOUNTABLE CARE$5,571
EMBARC BENEFIT PROTECTION$4,400
HOSPITAL P4P$86
HOSPITAL P4P OUTPATIENT$361
MEDICAL ONCOLOGY TREATMENT FEE$1,103
MEDSOLUTIONS RADIOLOGY CAP$14,132
MENTAL HEALTH CAP$183,099
MSI MUSCULOSKELETAL PRECERT$1,817
RADIATION THERAPY CASE FEE$958
SCC PERIODIC RECONCILIATION$319
SHARED SAVINGS CAC$12
Feb-2024 Total$215,003
Mar-24AGNOSTIC ADMIN CAP$3,154
COLLABORATIVE ACCOUNTABLE CARE$6,240
EMBARC BENEFIT PROTECTION($24,473)
HOSPITAL P4P$10,130
HOSPITAL P4P OUTPATIENT$10,224
MEDICAL ONCOLOGY TREATMENT FEE$2,206
MEDSOLUTIONS RADIOLOGY CAP$14,072
MENTAL HEALTH CAP$182,527
MSI MUSCULOSKELETAL PRECERT$1,824
RADIATION THERAPY CASE FEE$1,916
Mar-2024 Total$207,819
Apr-24AGNOSTIC ADMIN CAP$3,153
COLLABORATIVE ACCOUNTABLE CARE$6,094
EMBARC BENEFIT PROTECTION$4,392
HOSPITAL P4P$4,923
HOSPITAL P4P OUTPATIENT$5,800
MEDICAL ONCOLOGY TREATMENT FEE$1,103
MEDSOLUTIONS RADIOLOGY CAP$13,884
MENTAL HEALTH CAP$182,526
MSI MUSCULOSKELETAL PRECERT$1,820
RADIATION THERAPY CASE FEE$1,916
SHARED SAVINGS CAC$6
Apr-2024 Total$225,617
May-24AGNOSTIC ADMIN CAP$3,164
COLLABORATIVE ACCOUNTABLE CARE$6,040
EMBARC BENEFIT PROTECTION$4,419
HOSPITAL P4P OUTPATIENT$97
MEDICAL ONCOLOGY TREATMENT FEE$2,206
MEDSOLUTIONS RADIOLOGY CAP$14,111
MENTAL HEALTH CAP$183,260
MSI MUSCULOSKELETAL PRECERT$1,829
SCC PERIODIC RECONCILIATION$349
SHARED SAVINGS CAC$11
May-2024 Total$215,486
Jun-24AGNOSTIC ADMIN CAP$3,162
COLLABORATIVE ACCOUNTABLE CARE$4,972
EMBARC BENEFIT PROTECTION$4,411
HOSPITAL P4P OUTPATIENT$195
MEDSOLUTIONS RADIOLOGY CAP$14,109
MENTAL HEALTH CAP$183,350
MSI MUSCULOSKELETAL PRECERT$1,827
SCC PERIODIC RECONCILIATION$4,613
SHARED SAVINGS CAC$3
Jun-2024 Total$216,644
Jul-24AGNOSTIC ADMIN CAP$3,144
COLLABORATIVE ACCOUNTABLE CARE$4,846
EMBARC BENEFIT PROTECTION$4,385
HOSPITAL P4P OUTPATIENT$31
MEDICAL ONCOLOGY TREATMENT FEE$1,103
MEDSOLUTIONS RADIOLOGY CAP$14,033
MENTAL HEALTH CAP$182,198
MSI MUSCULOSKELETAL PRECERT$1,816
RADIATION THERAPY CASE FEE$958
SHARED SAVINGS CAC$6
Jul-2024 Total$212,518
Aug-24AGNOSTIC ADMIN CAP$3,146
COLLABORATIVE ACCOUNTABLE CARE$4,826
EMBARC BENEFIT PROTECTION$4,392
HOSPITAL P4P$1,188
HOSPITAL P4P OUTPATIENT$871
MEDSOLUTIONS RADIOLOGY CAP$14,029
MENTAL HEALTH CAP$182,486
MSI MUSCULOSKELETAL PRECERT$1,819
RADIATION THERAPY CASE FEE$1,916
SCC PERIODIC RECONCILIATION$355
SHARED SAVINGS CAC$0
Aug-2024 Total$215,028
Sep-24AGNOSTIC ADMIN CAP$3,145
COLLABORATIVE ACCOUNTABLE CARE$4,692
EMBARC BENEFIT PROTECTION$4,388
HOSPITAL P4P$2,629
HOSPITAL P4P OUTPATIENT$5,859
MEDSOLUTIONS RADIOLOGY CAP$14,026
MENTAL HEALTH CAP$182,280
MSI MUSCULOSKELETAL PRECERT$1,817
SCC PERIODIC RECONCILIATION$46,009
SHARED SAVINGS CAC$73
Sep-2024 Total$264,917
Oct-24AGNOSTIC ADMIN CAP$2,436
COLLABORATIVE ACCOUNTABLE CARE$4,715
EMBARC BENEFIT PROTECTION$4,385
HOSPITAL P4P OUTPATIENT$94
MEDICAL ONCOLOGY TREATMENT FEE$1,103
MENTAL HEALTH CAP$182,239
RADIATION THERAPY CASE FEE$1,916
Oct-2024 Total$196,888
Nov-24AGNOSTIC ADMIN CAP$3,848
COLLABORATIVE ACCOUNTABLE CARE$4,630
EMBARC BENEFIT PROTECTION$4,384
HOSPITAL P4P$27
HOSPITAL P4P OUTPATIENT$116
MEDICAL ONCOLOGY TREATMENT FEE$3,309
MEDSOLUTIONS RADIOLOGY CAP$28,041
MENTAL HEALTH CAP$207,502
MSI MUSCULOSKELETAL PRECERT$3,631
RADIATION THERAPY CASE FEE$1,916
SCC PERIODIC RECONCILIATION$229
SHARED SAVINGS CAC$7
Nov-2024 Total$257,639
Dec-24AGNOSTIC ADMIN CAP$3,101
COLLABORATIVE ACCOUNTABLE CARE($428)
EMBARC BENEFIT PROTECTION$4,325
HOSPITAL P4P$4,627
HOSPITAL P4P OUTPATIENT$5,220
MEDSOLUTIONS RADIOLOGY CAP$13,838
MENTAL HEALTH CAP$205,027
MSI MUSCULOSKELETAL PRECERT$1,792
Dec-2024 Total$237,502
FIXED CHARGES/CAP TYPE TotalsAGNOSTIC ADMIN CAP$37,519
COLLABORATIVE ACCOUNTABLE CARE$57,676
EMBARC BENEFIT PROTECTION$23,729
HOSPITAL P4P$23,610
HOSPITAL P4P OUTPATIENT$28,868
MEDICAL ONCOLOGY TREATMENT FEE$14,233
MEDSOLUTIONS RADIOLOGY CAP$154,313
MENTAL HEALTH CAP$2,056,631
MSI MUSCULOSKELETAL PRECERT$21,738
RADIATION THERAPY CASE FEE$12,408
SCC PERIODIC RECONCILIATION$51,876
SHARED SAVINGS CAC$117
Grand Total$2,482,716

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