Exhibit 52a - Cal Yr 2022 City of Miami CIGNA Pooled Stop Loss High Claims Greater than 50K Experience De-ID.xlsx

XLSX spreadsheet 35 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 de-identified claims experience report for the City of Miami's CIGNA Pooled Stop Loss insurance program for calendar year 2022, covering high claims exceeding $50,000. The report details medical claims across various employee categories including active employees (general, SEA, M/C), executives/elected officials, and non-Medicare retirees, with claims tracked across different demographic segments such as age bands, gender, and specific medical conditions.

The claims data reveals a comprehensive breakdown of medical expenses, with individual claims ranging from approximately $15,000 to over $350,000 for conditions including cancer, heart disease, transplant-related issues, chronic conditions, and various surgical interventions. The report uses a network open access POS (point of service) plan structure, with claims categorized by diagnosis codes, age bands (from 1-17 to 65+ years), and employee classifications, providing a detailed retrospective experience-rated analysis of the city's health insurance claims for risk assessment and future planning purposes.

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Clms Exc ID Dx R12-1

CITY OF MIAMI
CLAIMS EXCEEDING REPORT
January 2022 thru December 2022
EXHIBIT 52a
Rating Type : POOLED STOP LOSS, RETROSPECTIVE EXPERIENCE RATED
Claims Exceeding : $50,000.00
Reported Claims: InNet, OutNet, Drug
Note: Diagnosis is based on the largest medical claim amount
BENEFIT OPTIONBRANCHFUNDING TYPERATING TYPERELGENDERAGE BANDICD CODEICD DESCRIPTIONICD VERSIONDRUG CLAIMSPAID CLAIMSCLAIMANT TOTAL
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RSPM50-59L409PSORIASIS, UNSPECIFIED10$37,987$119$38,106
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM50-59Z0000ENCNTR FOR GENERAL ADULT MEDICAL EXAM W/O ABNORMAL FINDINGS10$37,884$182$38,066
$75,871$301$76,172
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM60-64N390URINARY TRACT INFECTION, SITE NOT SPECIFIED10$2,717$66,954$69,671
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM65+J320CHRONIC MAXILLARY SINUSITIS10$1$15,817$15,817
$2,718$82,770$85,488
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM60-64PHPHARMACY*($305)$0($305)
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM65+K430INCISIONAL HERNIA WITH OBSTRUCTION, WITHOUT GANGRENE10$33,568$31,507$65,075
$33,263$31,507$64,770
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEM50-59I132HYP HRT & CHR KDNY DIS W HRT FAIL AND W STG 5 CHR KDNY/ESRD10$9,171$139,083$148,254
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59H4311VITREOUS HEMORRHAGE, RIGHT EYE10$26,647$47,319$73,965
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64K8510BILIARY ACUTE PANCREATITIS WITHOUT NECROSIS OR INFECTION10$631$189,908$190,539
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2RSPF30-39K8010CALCULUS OF GALLBLADDER W CHRONIC CHOLECYST W/O OBSTRUCTION10$10,203$54,535$64,738
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM18-29N319NEUROMUSCULAR DYSFUNCTION OF BLADDER, UNSPECIFIED10$4,477$59,558$64,035
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM18-29K760FATTY (CHANGE OF) LIVER, NOT ELSEWHERE CLASSIFIED10$94,831$1,071$95,902
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM30-39R7401ELEVATION OF LEVELS OF LIVER TRANSAMINASE LEVELS10$132$230$362
$94,962$1,302$96,264
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAMC-ACTIVE EMPLOYEES (M/C)2REEM60-64A419SEPSIS, UNSPECIFIED ORGANISM10$576$25,124$25,700
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRMC1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM60-64A419SEPSIS, UNSPECIFIED ORGANISM10$3,954$210,488$214,442
$4,530$235,612$240,142
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS1MEEF40-49*UNSPECIFIED*$0$5,026$5,026
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEF40-49K5090CROHN'S DISEASE, UNSPECIFIED, WITHOUT COMPLICATIONS10$50,551$299,190$349,741
$50,551$304,216$354,767
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM1-17E230HYPOPITUITARISM10$116,076$849$116,924
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RSPF50-59Z1231ENCNTR SCREEN MAMMOGRAM FOR MALIGNANT NEOPLASM OF BREAST10$182,514$1,964$184,478
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39E288OTHER OVARIAN DYSFUNCTION10$809$54,859$55,668
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEM50-59K3580UNSPECIFIED ACUTE APPENDICITIS10$13,102$38,105$51,207
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49M4722OTHER SPONDYLOSIS WITH RADICULOPATHY, CERVICAL REGION10$85$53,241$53,326
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF50-59N939ABNORMAL UTERINE AND VAGINAL BLEEDING, UNSPECIFIED10$3$854$856
$88$54,095$54,183
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF30-39N6459OTHER SIGNS AND SYMPTOMS IN BREAST10$58,355$2,309$60,664
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49Z01419ENCNTR FOR GYN EXAM (GENERAL) (ROUTINE) W/O ABN FINDINGS10$20,467$704$21,171
$78,822$3,013$81,835
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAMC-ACTIVE EMPLOYEES (M/C)2RSPM65+H2511AGE-RELATED NUCLEAR CATARACT, RIGHT EYE10$11,507$60,000$71,507
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEM18-29*UNSPECIFIED*$0$32,583$32,583
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM18-29D619APLASTIC ANEMIA, UNSPECIFIED10$174,363$16,192$190,555
$174,363$48,775$223,138
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM65+I130HYP HRT & CHR KDNY DIS W HRT FAIL AND STG 1-4/UNSP CHR KDNY10$162,584$71,232$233,816
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEM50-59H6983OTHER SPECIFIED DISORDERS OF EUSTACHIAN TUBE, BILATERAL10$19,196$3,648$22,844
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59L408OTHER PSORIASIS10$38,489$1,053$39,542
$57,685$4,701$62,386
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64R0600DYSPNEA, UNSPECIFIED10$7,123$3,470$10,593
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF65+I472VENTRICULAR TACHYCARDIA10$2,930$93,666$96,596
$10,053$97,136$107,189
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$160$153,372$153,531
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF50-59Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$633$58,106$58,739
$793$211,478$212,271
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM40-49L720EPIDERMAL CYST10$1,686$53,280$54,966
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM1-17K529NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED10$6,968$47,807$54,775
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59C50112MALIGNANT NEOPLASM OF CENTRAL PORTION OF LEFT FEMALE BREAST10$38$53,421$53,460
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEF50-59PHPHARMACY*$164$0$164
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEM50-59C182MALIGNANT NEOPLASM OF ASCENDING COLON10$1,779$126,046$127,824
$1,943$126,046$127,989
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MSPM50-59*UNSPECIFIED*$0$222,264$222,264
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM50-59K8301PRIMARY SCLEROSING CHOLANGITIS10$38,760$311,210$349,970
$38,760$533,474$572,234
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49I10ESSENTIAL (PRIMARY) HYPERTENSION10$50$51,631$51,681
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59R42DIZZINESS AND GIDDINESS10$40,784$10,924$51,708
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MCHF18-29*UNSPECIFIED*$0$43,881$43,881
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF1-17Z941HEART TRANSPLANT STATUS10$0$218$218
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF18-29T8621HEART TRANSPLANT REJECTION10$18,758$330,903$349,662
$18,758$375,003$393,761
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59C50812MALIGNANT NEOPLASM OF OVRLP SITES OF LEFT FEMALE BREAST10$127,377$113,750$241,126
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59Z1211ENCOUNTER FOR SCREENING FOR MALIGNANT NEOPLASM OF COLON10$49,633$4,645$54,278
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49K50118CROHN'S DISEASE OF LARGE INTESTINE WITH OTHER COMPLICATION10$0$135,865$135,866
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59T8130XADISRUPTION OF WOUND, UNSPECIFIED, INITIAL ENCOUNTER10$3,372$119,885$123,256
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF<-1Z3801SINGLE LIVEBORN INFANT, DELIVERED BY CESAREAN10$189$53,590$53,779
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF18-29O42012PRETRM PREM ROM, ONSET LABOR W/N 24 HOURS OF RUPT, 2ND TRI10$0$50,480$50,480
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEF40-49K8590ACUTE PANCREATITIS WITHOUT NECROSIS OR INFECTION, UNSP10$1,593$86,160$87,753
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM30-39G129SPINAL MUSCULAR ATROPHY, UNSPECIFIED10$0$59,475$59,475
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RSPF50-59S83231ACOMPLEX TEAR OF MEDIAL MENSC, CURRENT INJURY, R KNEE, INIT10$53,333$4,045$57,379
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF50-59S83281DOTH TEAR OF LAT MENSC, CURRENT INJURY, RIGHT KNEE, SUBS10$52,252$11,286$63,537
$105,585$15,331$120,916
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49K529NONINFECTIVE GASTROENTERITIS AND COLITIS, UNSPECIFIED10$183,156$6,356$189,512
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64R921MAMMOGRAPHIC CALCIFCN FOUND ON DIAGNOSTIC IMAGING OF BREAST10$68,905$10,281$79,186
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM30-39L400PSORIASIS VULGARIS10$56,866$645$57,511
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF<-1Z3801SINGLE LIVEBORN INFANT, DELIVERED BY CESAREAN10$0$316,122$316,122
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF30-39O1414SEVERE PRE-ECLAMPSIA COMPLICATING CHILDBIRTH10$72$64,336$64,408
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49R519HEADACHE, UNSPECIFIED10$2$45$47
$73$64,381$64,454
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEM60-64C61MALIGNANT NEOPLASM OF PROSTATE10$0$46,520$46,520
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEM65+Z510ENCOUNTER FOR ANTINEOPLASTIC RADIATION THERAPY10$60,196$44,408$104,603
$60,196$90,928$151,123
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM18-29K5010CROHN'S DISEASE OF LARGE INTESTINE WITHOUT COMPLICATIONS10$44,702$12,857$57,560
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM30-39K51519LEFT SIDED COLITIS WITH UNSPECIFIED COMPLICATIONS10$108,923$22,465$131,388
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM50-59L4050ARTHROPATHIC PSORIASIS, UNSPECIFIED10$53,119$334$53,453
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49K430INCISIONAL HERNIA WITH OBSTRUCTION, WITHOUT GANGRENE10$45,643$42,035$87,679
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59M1712UNILATERAL PRIMARY OSTEOARTHRITIS, LEFT KNEE10$0$441$441
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM60-64I480PAROXYSMAL ATRIAL FIBRILLATION10$15,623$81,612$97,235
$15,623$82,053$97,676
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49E1169TYPE 2 DIABETES MELLITUS WITH OTHER SPECIFIED COMPLICATION10$3,652$153,028$156,679
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59PHPHARMACY*$435$0$435
$4,086$153,028$157,114
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39Z20822CONTACT WITH AND (SUSPECTED) EXPOSURE TO COVID1910$22,101$245$22,346
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49G35MULTIPLE SCLEROSIS10$67,939$135$68,073
$90,040$380$90,420
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM65+C641MALIGNANT NEOPLASM OF RIGHT KIDNEY, EXCEPT RENAL PELVIS10$1,163$77,227$78,390
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49E11621TYPE 2 DIABETES MELLITUS WITH FOOT ULCER10$8,932$121,084$130,016
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2RSPF40-49G4733OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)10$0$40$40
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2RSPF50-59R0789OTHER CHEST PAIN10$10,939$39,884$50,823
$10,939$39,924$50,862
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEM60-64U071COVID-1910$15,712$43,538$59,250
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEM65+D3612BEN NEOPLM OF PRPH NRV & AUTONM NRV SYS, UPR LMB, INC SHLDR10$140$12,504$12,644
$15,852$56,042$71,894
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2RCHF18-29K3184GASTROPARESIS10$1,770$237,217$238,987
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39E6601MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES10$398$107,370$107,768
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEM50-59I4891UNSPECIFIED ATRIAL FIBRILLATION10$4,483$51,049$55,532
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF18-29C73MALIGNANT NEOPLASM OF THYROID GLAND10$30$60,218$60,248
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEF50-59*UNSPECIFIED*$0$74,731$74,731
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59U071COVID-1910$0$349,961$349,961
$0$424,692$424,692
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59N813COMPLETE UTEROVAGINAL PROLAPSE10$1,196$50,350$51,545
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)MRG1-MEDICARE RETIREE 65+ W/ DEP UNDER 652REEF60-64M5450LOW BACK PAIN, UNSPECIFIED10$91,535$58,531$150,066
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEF50-59*UNSPECIFIED*$0$285,432$285,432
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$8,846$341,088$349,935
$8,846$626,521$635,367
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM65+N401BENIGN PROSTATIC HYPERPLASIA WITH LOWER URINARY TRACT SYMP10$717$52,631$53,348
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39O200THREATENED ABORTION10$5$15,780$15,785
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49O1414SEVERE PRE-ECLAMPSIA COMPLICATING CHILDBIRTH10$445$40,872$41,317
$451$56,652$57,103
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM60-64R0789OTHER CHEST PAIN10$1,543$95,743$97,286
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49Z1501GENETIC SUSCEPTIBILITY TO MALIGNANT NEOPLASM OF BREAST10$0$68,984$68,984
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEF50-59B20HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE10$40,052$941$40,993
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETE1-NON-MEDICARE RETIREE W/DEP - 652REEF50-59B20HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE10$20,057$295$20,352
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETE1-NON-MEDICARE RETIREE W/DEP - 652REEF60-64PHPHARMACY*$742$0$742
$60,851$1,236$62,087
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEF60-64PHPHARMACY*$273$0$273
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM60-64G8194HEMIPLEGIA, UNSPECIFIED AFFECTING LEFT NONDOMINANT SIDE10$5,745$122,842$128,586
$6,018$122,842$128,860
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM30-39A4151SEPSIS DUE TO ESCHERICHIA COLI [E. COLI]10$0$85,577$85,577
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MSPM65+*UNSPECIFIED*$0$205,883$205,883
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM65+Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$6,368$347,389$353,757
$6,368$553,273$559,640
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64I213ST ELEVATION (STEMI) MYOCARDIAL INFARCTION OF UNSP SITE10$3,118$165,600$168,717
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF1-17R269UNSPECIFIED ABNORMALITIES OF GAIT AND MOBILITY10$35$52,748$52,783
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NASEA-ACTIVE EMPLOYEES (SEA)2REEF40-49M3214GLOMERULAR DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS10$6,524$79,702$86,226
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM65+S2232XAFRACTURE OF ONE RIB, LEFT SIDE, INIT FOR CLOS FX10$1,865$88,273$90,138
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF65+I4891UNSPECIFIED ATRIAL FIBRILLATION10$9,788$110,115$119,903
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49A4150GRAM-NEGATIVE SEPSIS, UNSPECIFIED10$7,870$107,053$114,922
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39Z03818ENCNTR FOR OBS FOR SUSP EXPSR TO OTH BIOLG AGENTS RULED OUT10$839$637$1,476
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49R55SYNCOPE AND COLLAPSE10$7,040$44,013$51,053
$7,880$44,650$52,530
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF65+E6601MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES10$1,072$57,815$58,887
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49K51019ULCERATIVE (CHRONIC) PANCOLITIS WITH UNSP COMPLICATIONS10$877$35,608$36,485
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59K5100ULCERATIVE (CHRONIC) PANCOLITIS WITHOUT COMPLICATIONS10$21,227$19,909$41,136
$22,104$55,517$77,622
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64C50812MALIGNANT NEOPLASM OF OVRLP SITES OF LEFT FEMALE BREAST10$54,090$95,966$150,056
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652RCHM1-17A045CAMPYLOBACTER ENTERITIS10$0$45,359$45,359
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652RCHM18-29I071RHEUMATIC TRICUSPID INSUFFICIENCY10$0$5,984$5,984
$0$51,343$51,343
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MSPF50-59*UNSPECIFIED*$0$174,849$174,849
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF50-59Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$17$349,983$350,000
$17$524,832$524,849
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEF60-64T8549XAMECH COMPL OF BREAST PROSTHESIS AND IMPLANT, INIT ENCNTR10$11,418$78,423$89,841
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59T8544XACAPSULAR CONTRACTURE OF BREAST IMPLANT, INITIAL ENCOUNTER10$5,687$47,998$53,685
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF18-29R54AGE-RELATED PHYSICAL DEBILITY10$328$55,465$55,793
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAMC-ACTIVE EMPLOYEES (M/C)2RSPM40-49E113511TYPE 2 DIAB WITH PROLIF DIAB RTNOP WITH MACULAR EDEMA, R EYE10$28,191$23,504$51,695
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59N486INDURATION PENIS PLASTICA10$253$72,699$72,953
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59H35052RETINAL NEOVASCULARIZATION, UNSPECIFIED, LEFT EYE10$1,097$58,684$59,780
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEF50-59N186END STAGE RENAL DISEASE10($2,443)$31,651$29,208
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEF60-64N186END STAGE RENAL DISEASE10$22,882$132,163$155,045
$20,439$163,814$184,253
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM65+I7101DISSECTION OF THORACIC AORTA10$1,094$254,743$255,838
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MCHF1-17*UNSPECIFIED*$0$50,412$50,412
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHF1-17G129SPINAL MUSCULAR ATROPHY, UNSPECIFIED10$366,155($16,197)$349,958
$366,155$34,215$400,370
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RCHF18-29O26891OTH PREGNANCY RELATED CONDITIONS, FIRST TRIMESTER10$152,158$4,820$156,977
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM18-29Z03818ENCNTR FOR OBS FOR SUSP EXPSR TO OTH BIOLG AGENTS RULED OUT10$64,385$398$64,783
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RSPF40-49K5100ULCERATIVE (CHRONIC) PANCOLITIS WITHOUT COMPLICATIONS10$5,230$45,830$51,060
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF40-49C50411MALIG NEOPLM OF UPPER-OUTER QUADRANT OF RIGHT FEMALE BREAST10$142,145$106,348$248,493
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEF60-64*UNSPECIFIED*$0$493$493
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64G4733OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)10$372,353$2,870$375,223
$372,353$3,363$375,716
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAMC-ACTIVE EMPLOYEES (M/C)2REEM40-49M4712OTHER SPONDYLOSIS WITH MYELOPATHY, CERVICAL REGION10$29$89,847$89,876
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2RCHM1-17K5090CROHN'S DISEASE, UNSPECIFIED, WITHOUT COMPLICATIONS10$47$56,994$57,040
NPOS2-STANDALONE NETWORK POS PLAN COPY NO RXRMEPDP-RETIRED MEDICARE ELIGIBLE W/PDP PLAN2REEM60-64G6181CHRONIC INFLAMMATORY DEMYELINATING POLYNEURITIS10$0$140,436$140,436
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPF60-64Z5111ENCOUNTER FOR ANTINEOPLASTIC CHEMOTHERAPY10$4,360$72,597$76,957
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEF60-64A419SEPSIS, UNSPECIFIED ORGANISM10$5,079$68,294$73,373
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEM40-49*UNSPECIFIED*$0$915$915
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49I480PAROXYSMAL ATRIAL FIBRILLATION10$42,976$192,808$235,784
$42,976$193,723$236,700
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF40-49PHPHARMACY*$40$0$40
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM40-49S72351ADISPLACED COMMINUTED FRACTURE OF SHAFT OF RIGHT FEMUR, INIT10$1,193$110,037$111,230
$1,233$110,037$111,270
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM18-29K5000CROHN'S DISEASE OF SMALL INTESTINE WITHOUT COMPLICATIONS10$96,799$135$96,934
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM60-64E611IRON DEFICIENCY10$30,971$26,328$57,299
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64K8000CALCULUS OF GALLBLADDER W ACUTE CHOLECYST W/O OBSTRUCTION10$25$52,380$52,406
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF30-39O480POST-TERM PREGNANCY10$329$55,073$55,402
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MEEM60-64*UNSPECIFIED*$0$1,328$1,328
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF60-64PHPHARMACY*$647$0$647
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM60-64U071COVID-1910$1,827$347,150$348,978
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 651MEEM60-64*UNSPECIFIED*$0$2,724$2,724
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NRETG1-NON-MEDICARE RETIREE - 65 W/ DEP - 652REEM60-64I10ESSENTIAL (PRIMARY) HYPERTENSION10$546($461)$85
$3,020$350,742$353,762
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59G35MULTIPLE SCLEROSIS10$70$80,888$80,958
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEF50-59J390RETROPHARYNGEAL AND PARAPHARYNGEAL ABSCESS10$5,986$101,000$106,987
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)1MCHM1-17*UNSPECIFIED*$0$337,423$337,423
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RCHM1-17D619APLASTIC ANEMIA, UNSPECIFIED10$144,953$205,047$350,000
$144,953$542,470$687,423
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)E1211-EXECUTIVES/ELECTED OFFICIALS2REEM40-49I214NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION10$16,707$253,671$270,378
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM50-59I2510ATHSCL HEART DISEASE OF NATIVE CORONARY ARTERY W/O ANG PCTRS10$462$109,618$110,079
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2REEM60-64I259CHRONIC ISCHEMIC HEART DISEASE, UNSPECIFIED10$107$1,536$1,643
$569$111,154$111,723
NPOS-NETWORK OPEN ACCESS POS (ALL EMPLOYEES)NAGEN-ACTIVE EMPLOYEES (GENERAL)2RSPM60-64N186END STAGE RENAL DISEASE10$2,751$140,449$143,199

Grand Total $4,111,781 $12,262,245 $16,374,026

&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: 1/6/2023

&7Cigna makes no warranty, express or implied, as to content and disclaims all liability arising directly or indirectly from use or reliance upon its contents by any third party even if Cigna has been advised of an intended use.

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